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Myrna K. Nussbaum

Radiology

Allopathic & Osteopathic Physicians

227 Franklin Ave, Hewlett, NY 11557-1902

PECOS Enrollment

This provider is enrolled in PECOS as MYRNA NUSSBAUM.

Based on the most recent information from CMS, provider Myrna K. Nussbaum is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 12:57 PM.

Profile Details

Provider ID
1972580926
Provider Type
Individual
Full Name
Nussbaum, Myrna K.
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
12/29/2005
Last Updated
12/22/2011

Contact Information

Practice Location

227 Franklin Ave, Hewlett, NY 11557-1902

(516) 295-5500

(516) 569-8225

Mailing Location

545 Elmont Rd, Elmont, NY 11003-4002

(516) 354-4200

(516) 775-1972

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License 157104 New York

Provider Identifiers

ID	Description	Issuer
ID 01967477	Description Medicaid	Issuer Unlisted New York

Myrna K. Nussbaum

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Long Island Radiology Associates, Pc

Gelber, Howard J.

Ryoo, Simon

Schulze, Gerald J.

Community Radiology Service, Pc

Singer, Michael B.

Diament, Matthew A.

Nuba, Robert Samuel

Mccleavey, James R.