Provider Demographics
NPI:1871724351
Name:NUSSBAUM, YEHUDA L (DO)
Entity type:Individual
Prefix:DR
First Name:YEHUDA
Middle Name:L
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 RIDGEWAY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4127
Mailing Address - Country:US
Mailing Address - Phone:585-922-0900
Mailing Address - Fax:
Practice Address - Street 1:2350 RIDGEWAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4127
Practice Address - Country:US
Practice Address - Phone:585-922-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY264436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program