Healthcare Provider Details

I. General information

NPI: 1558522748
Provider Name (Legal Business Name): INNA NUTANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HIGH ST APT G42
FAIR LAWN NJ
07410-6414
US

IV. Provider business mailing address

302 HIGH ST APT G42
FAIR LAWN NJ
07410-6414
US

V. Phone/Fax

Practice location:
  • Phone: 201-835-8246
  • Fax:
Mailing address:
  • Phone: 201-835-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number264904-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number264904-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: