Provider Demographics
NPI:1215917935
Name:NUSSBAUM, MICHEL ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:ERNEST
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:201 E 17TH ST APT 3H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3675
Mailing Address - Country:US
Mailing Address - Phone:917-952-6010
Mailing Address - Fax:212-254-8045
Practice Address - Street 1:163-03 HORACE HARDING EXPRESSWAY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1136
Practice Address - Country:US
Practice Address - Phone:718-670-2386
Practice Address - Fax:718-460-6869
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY136263207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10P0341OtherNY HOSPITAL COMM PLAN
NY666001OtherUNITED HEALTH CARE
NY0539960OtherAETNA
NY071A4110OtherBLUE CROSS
NY159885OtherELDERPLAN
NYDS583OtherOXFORD
NY0C0936OtherHEALTH NET
NY00734556Medicaid
NYOH752POtherHEALTH CARE PARTNERS
NY0084958OtherGHI
NY159885OtherELDERPLAN
NY84958Medicare ID - Type Unspecified