Michael Nussbaum, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

124424 Issued in NY

Practice address

270 Union Ave
Holbrook, NY 11741-1823

Phone

(631) 588-4442

NPI assigned

Aug 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321920000000",
    "number": "1356458442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 OLD HOMESTEAD RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 UNION AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411823",
            "telephone_number": "631-588-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUSSBAUM",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2011-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "124424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00306170",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary O Newman, MS
• Catherine Josephine Nicosia, R.N.
• Kassandra M Nitti
• Bobby J Noghrey, DO
• North Shore University Hospital Manhasset
• Nutrition Thyme, LLC
• Karen Ann O Mahony
• Shaun Patrick O'Connell, PHYSICIAN ASSISTANT
• Jennifer Obijuru, OT
• Joanne I Oconnor, LCSW SOCIAL WORKER

• Pediatric Adolescent Medicine Physician in Holbrook, NY
• Providers in Holbrook, NY by specialty
• Pediatric Adolescent Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.