1104336965 NPI number — MRS. MOLLY NUSSBAUM SCHULMAN N.P.

Table of content: MRS. MOLLY NUSSBAUM SCHULMAN N.P. (NPI 1104336965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104336965 NPI number — MRS. MOLLY NUSSBAUM SCHULMAN N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULMAN
Provider First Name:
MOLLY
Provider Middle Name:
NUSSBAUM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NUSSBAUM
Provider Other First Name:
MOLLY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104336965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 PROSPECT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPPAQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10514-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-775-1345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 WESTCHESTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HARRISON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10604-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-367-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  308488 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05044853 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".