Healthcare Provider Details

I. General information

NPI: 1588539852
Provider Name (Legal Business Name): ORA NUSBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 MYRTLE AVE
RICHMOND HILL NY
11418-1751
US

IV. Provider business mailing address

11711 MYRTLE AVE
RICHMOND HILL NY
11418-1751
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-6300
  • Fax: 718-849-9695
Mailing address:
  • Phone: 718-849-6300
  • Fax: 718-849-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: