MEDICARE: EPHRAIM NUSSBAUM

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	106H00000X	Marriage & Family Therapist	37FA00065900	NJ

General Provider Information

NPI Number	:	1972436913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EPHRAIM NUSSBAUM

Provider Business Mailing Address
First Line	:	186 MELVILLE AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4235
Country	:	US
Telephone Number	:	732-966-4926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 SWARTHMORE AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4565
Country	:	US
Telephone Number	:	732-966-4926
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ EPHRAIM NUSSBAUM ” Practice Location

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