Healthcare Provider Details

I. General information

NPI: 1891635116
Provider Name (Legal Business Name): OLIVIA NUSSBAUM MD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E RIDGEWOOD AVE STE 570N
PARAMUS NJ
07652-3917
US

IV. Provider business mailing address

140 E RIDGEWOOD AVE STE 570N
PARAMUS NJ
07652-3917
US

V. Phone/Fax

Practice location:
  • Phone: 201-251-3381
  • Fax:
Mailing address:
  • Phone: 201-251-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNONE
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: