Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Z Nussbaum, MD

Individual provider Family Medicine Physician · NPI 1346242690

Jack Z Nussbaum, MD is a Family Practice in Lake Ronkonkoma, New York. Graduated from Icahn School of Medicine at Mount Sinai in 1984, 42 years ago. Practices with Theodore Fried Burford Welch and David Hauer MD, PC, a 2-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
42
Trained at
Icahn School of Medicine at Mount Sinai
Licensed in
NY
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

388 Hawkins Ave Ste 1
Lake Ronkonkoma, NY 11779-4280
Phone: (631) 588-8460
Fax: (631) 588-8480
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 165161 (NY)

Record details

NPI number1346242690
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 1, 2005
Last updated in NPPESJuly 13, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Graduated 1984 (42 years in practice)
Group practice Theodore Fried Burford Welch And David Hauer Md, Pc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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