Marcy Nussbaum
Individual provider Active NPI Speech-Language Pathologist · Broad Channel, NY
NPI 1992248686 · NPPES record last updated Nov 29, 2016
Key facts
- NPI
- 1992248686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 008103-1 (NY)
- Practice address
- 9 Power Rd
Broad Channel, NY 11693-1103 - Phone
- (718) 634-7167
- NPI assigned
- Nov 29, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008103-1 | NY | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 008103-1 | NY | Yes |
Addresses
Primary practice location
9 Power Rd
Broad Channel, NY 11693-1103
Mailing address
9 Power Rd
Broad Channel, NY 11693-1103
Phone (718) 634-7167
Other providers in Broad Channel, NY
- Marianthi Koullias
- Kerry Ann Larkin
- Ann M Mills
- Allison Ann Moynihan
- Marissa Ann Mundy
- Susan Oconnor
- Julia Rocco
- Linda Scott
- Jeanette Michelle Stewart
- Loretta Stone
All providers in Broad Channel, NY · Speech-Language Pathologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.