JACK NUSSBAUM, MD
Family Medicine
Active
Individual
NPI: 1346242690
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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