MEDICARE: DR. GERARD G NAHUM MD

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	207V00000X	Obstetrics & Gynecology Physician	9800983	NC
2	207V00000X	Obstetrics & Gynecology Physician	G56447	CA

General Provider Information

NPI Number	:	1154964773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD G NAHUM MD

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07474-0159
Country	:	US
Telephone Number	:	240-535-7882
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 CANAL XING
Second Line	:
City	:	LAKE HOPATCONG
State	:	NJ
Zip	:	07849-2419
Country	:	US
Telephone Number	:	973-262-7555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2019
Last Update Date	:	10/27/2019

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