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General NPI Number Information
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NPI Number | 1215917935
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Entity Type | Individual
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Provider Name | MICHEL ERNEST NUSSBAUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 163-03 HORACE HARDING EXPRESSWAY THIRD FLOOR
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-1136
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Country | US
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Telephone | 718-670-2386
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Fax | 718-460-6869
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Provider Business Mailing Address
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Address Line | 201 E 17TH ST APT 3H
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City | NEW YORK
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State | NY
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Zip | 10003-3675
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Country | US
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Telephone | 917-952-6010
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Fax | 212-254-8045
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 136263
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License Number State | NY
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