JACK NUSSBAUM, MD

Family Medicine

Active Individual
NPI: 1346242690

Practice Address

388 HAWKINS AVE
STE 1
Lake Ronkonkoma, NY 11779

Phone: (631) 588-8460

Specialties

Specialty Code Primary License
Family Medicine 207Q00000X Yes 165161 (NY)

Frequently Asked Questions

NPI 1346242690 is the National Provider Identifier for JACK NUSSBAUM, MD, a Family Medicine provider located in Lake Ronkonkoma, NY. This NPI was enumerated on June 1, 2005.
JACK NUSSBAUM, MD practices at 388 HAWKINS AVE, STE 1, Lake Ronkonkoma, NY 11779.

Quick Facts

NPI
1346242690
Type
Individual
Enumerated
Jun 1, 2005
Last Updated
Jul 8, 2007

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