| Jack Z Nussbaum, MD | |
|
388 Hawkins Ave, Ste 1, Lake Ronkonkoma, NY 11779-4280 | |
| (631) 588-8460 | |
| (631) 588-8480 |
| Full Name | Jack Z Nussbaum |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 42 Years |
| Location | 388 Hawkins Ave, Lake Ronkonkoma, New York |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346242690 | NPI | - | NPPES |
| 01824322 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 165161 (New York) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Catholic Home Care | Farmingdale, NY | Home health agency |
| St Catherine Of Siena Hospital | Smithtown, NY | Hospital |
| St Catherine Of Siena Nrsg And Rehab Care Center | Smithtown, NY | Nursing home |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Theodore Fried Burford Welch And David Hauer Md, Pc | 9830088103 | 2 |
| Entity Name | Theodore Fried Burford Welch & David Hauer Md, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1639233901 PECOS PAC ID: 9830088103 Enrollment ID: O20100218000494 |
| Entity Name | Vytaliz Medical |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1568831105 PECOS PAC ID: 7719296938 Enrollment ID: O20151028002361 |
| Mailing Address | Practice Location Address |
|---|---|
| Jack Z Nussbaum, MD 388 Hawkins Ave, Ste 1, Lake Ronkonkoma, NY 11779-4280 Ph: (631) 588-8460 | Jack Z Nussbaum, MD 388 Hawkins Ave, Ste 1, Lake Ronkonkoma, NY 11779-4280 Ph: (631) 588-8460 |
Robert Frederick Mazzeo, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 640 Hawkins Ave, Lake Ronkonkoma, NY 11779 Phone: 631-737-0100 Fax: 631-737-0100 | |
Khadiga Ahmed, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 640 Hawkins Ave, Lake Ronkonkoma, NY 11779 Phone: 631-471-0100 Fax: 631-471-1000 | |
Manuel R Rosales, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 388 Hawkins Ave, Ste 1, Lake Ronkonkoma, NY 11779 Phone: 631-588-8460 Fax: 631-588-8480 | |
Dr. David I Hauer, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 388 Hawkins Ave, Ste 1, Lake Ronkonkoma, NY 11779 Phone: 631-588-8460 Fax: 631-588-8480 | |
Dr. Bhanumathy Vinayagasundaram, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 640 Hawkins Avenue, Lake Ronkonkoma, NY 11779 Phone: 631-737-0100 Fax: 631-471-1117 | |
Robert Andrew Tufano, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 201 Portion Rd, Lake Ronkonkoma, NY 11779 Phone: 631-981-1333 Fax: 631-981-2326 |