Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 11829 | NJ |
NPI | 1003876079 |
---|---|
Provider Name | Dr. Burton L Nussbaum |
First Address | Cherry Hill, NJ 08002-2588 |
Second Address | Cherry Hill, NJ 08002-2550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2455706 | (05) | NJ |
U02546 | (02) | NJ |