Provider Demographics
NPI:1104336965
Name:SCHULMAN, MOLLY NUSSBAUM (NP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:NUSSBAUM
Last Name:SCHULMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3405
Mailing Address - Country:US
Mailing Address - Phone:301-775-1345
Mailing Address - Fax:
Practice Address - Street 1:500 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10604-3200
Practice Address - Country:US
Practice Address - Phone:914-367-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308488363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05044853Medicaid