Healthcare Provider Details

I. General information

NPI: 1821096017
Provider Name (Legal Business Name): DAVID N NUSSBAUM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 FIVE MILE WOODS RD
CATSKILL NY
12414-5913
US

IV. Provider business mailing address

6-15 15TH ST
FAIR LAWN NJ
07410-1603
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-6800
  • Fax:
Mailing address:
  • Phone: 201-791-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003109-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: