MEDICARE: ALAN L NISSENBAUM MEDICAL SERVICES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	177636	NY

General Provider Information

NPI Number	:	1053455998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN L NISSENBAUM MEDICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	2514 E 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6927
Country	:	US
Telephone Number	:	718-998-7592
Fax Number	:	718-444-2834

Provider Business Practice Location Address
First Line	:	2514 E 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6927
Country	:	US
Telephone Number	:	718-998-7592
Fax Number	:	718-444-2834

Authorized Official
Title or Position	:	CEO
Name	:	DR. ALAN LEON NISSENBAUM
Credential	:	MD
Telephone Number	:	718-998-7592

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	04/08/2014

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