Josef Nisenbaum, DO
Individual provider Active NPI Diagnostic Radiology Physician · Placitas, NM
NPI 1790789493 · NPPES record last updated Nov 21, 2019
Key facts
- NPI
- 1790789493
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- A-1195-02 (NM)
- Practice address
- 126 Diamond Tail Rd
Placitas, NM 87043-8338 - Phone
- (505) 264-3550
- Fax
- (505) 332-6921
- NPI assigned
- Jun 9, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040420000431 | NM | Practitioner - Interventional Radiology |
8325033111 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Imaging Associates of New Mexico LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Medical Radiologists Inc | Diagnostic Radiology | Past | Accepting new patients |
| Taos Mountain Radiology Inc | Diagnostic Radiology | Past | Accepting new patients |
| Empire State Radiology P C | Diagnostic Radiology | Past |
Accepting new patients |
Locations
1397 Weimer Rd
Taos, NM 87571
Phone (575) 751-5746
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | A-1195-02 | NM | |
| Diagnostic Radiology Physician | 2085R0202X | A-1195-02 | NM | Yes |
Addresses
Primary practice location
126 Diamond Tail Rd
Placitas, NM 87043-8338
Mailing address
126 Diamond Tail Rd
Placitas, NM 87043-8338
Phone (505) 264-3550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31201059 | Medicaid | NM |
Other providers in Placitas, NM
- M Candis McGuire Westby
- Adriana Medina
- Meridian Community Care LLC
- Shara Moscinska
- Jacque Newman
- Nutrition Redefined LLC
- Audrey Susan Petzold
- Placitas Chiropractic, LLC
- Placitas Healing Center LLC
- Jonathan Reade
All providers in Placitas, NM · Diagnostic Radiology Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.