Healthcare Provider Details

I. General information

NPI: 1346544194
Provider Name (Legal Business Name): BARTON NISONSON, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EAST 77TH ST
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

130 EAST 77TH ST
NEW YORK CITY NY
10075-1851
US

V. Phone/Fax

Practice location:
  • Phone: 212-570-9120
  • Fax: 212-717-4876
Mailing address:
  • Phone: 212-570-9120
  • Fax: 212-717-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number099856
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number099856
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number099856
License Number StateNY

VIII. Authorized Official

Name: MS. ROSEMARIE MAZZA
Title or Position: PHYSICIAN'S ASSISTANT/OFFICE MANAGE
Credential: OPA-C
Phone: 212-570-9120