Provider Demographics
NPI:1215073242
Name:N. ROBERT NUNBERG
Entity type:Organization
Organization Name:N. ROBERT NUNBERG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:N.
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NUNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-567-3338
Mailing Address - Street 1:41 WEST ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1349
Mailing Address - Country:US
Mailing Address - Phone:617-567-3338
Mailing Address - Fax:617-567-0822
Practice Address - Street 1:17 BENNINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1719
Practice Address - Country:US
Practice Address - Phone:617-567-3338
Practice Address - Fax:617-567-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1760213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77132Medicare ID - Type UnspecifiedMEDICARE GROUP NUNBER