Dr. Michael Leonard Nissenbaum
Cognitive & Behavioral Psychologist
2100 Middle Country Rd Suite 28w
Centereach
, New York 11720-3577
Dr. Michael Leonard Nissenbaum
Cognitive & Behavioral Psychologist
2100 Middle Country Rd Suite 28w
Centereach
, New York 11720-3577
(631) 737-9512
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About
Features
Specialties
- Cognitive & Behavioral Psychologist
Languages spoken
- English
Location
First Address
- Dr. Michael Leonard Nissenbaum
- Po Box 625
- Centereach, NY
- Zip : 11720-0625
- Fax : (631) 737-9512
- Phone : (631) 737-9500
Second Address
- Dr. Michael Leonard Nissenbaum
- 2100 Middle Country Rd Suite 28w
- Centereach, NY
- Zip : 11720-3577
- Fax : (631) 737-9512
- Phone : (631) 737-9500
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103TB0200X | Cognitive & Behavioral Psychologist | 010232 | NY |
National Provider Identifier
| NPI | 1174546725 |
|---|---|
| Provider Name | Dr. Michael Leonard Nissenbaum |
| First Address | Centereach, NY 11720-0625 |
| Second Address | Centereach, NY 11720-3577 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/07/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| R-53044 | (02) | NY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.