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General NPI Number Information
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NPI Number | 1164641221
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Entity Type | Individual
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Provider Name | ELLEN LORI NUSSBAUM D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11432 ROCKAWAY BEACH BLVD
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2302
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Country | US
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Telephone | 516-374-1190
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Fax | 516-569-4732
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Provider Business Mailing Address
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Address Line | 115 LAFAYETTE PLACE
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City | WOODMERE
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State | NY
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Zip | 11598
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Country | US
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Telephone | 516-374-1190
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Fax | 718-474-3791
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X007342-1
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License Number State | NY
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