Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 50940 | MA |
N | 111NI0900X | Internist | 50940 | MA |
Y | 207RG0300X | Geriatric Medicine | 50940 | MA |
NPI | 1144320334 |
---|---|
Provider Name | Dr. Neil Nusbaum |
First Address | Leeds, MA 01053-9764 |
Second Address | Leeds, MA 01053-9764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 21/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B19349 | (02) | IL |