DR. MARK NISSENBAUM (NPI# 1902897184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902897184 |
| Entity Type | Individual |
| Full Name | DR. MARK NISSENBAUM |
| Credential | DMD MDC FCDSA OMFS |
| Practice Address |
200 Boylston St Suite 305 Chestnut Hill MA 02467-2012 |
| Practice Telephone | 6177318888 |
| Practice Fax Number | 6177313107 |
| Mailing Telephone | 6177318888 |
| Mailing Fax Number | 6177313107 |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2014-02-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | 8460 | MA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003894502 | Mark Bruce Nissenbaum | Internal Medicine | 3701 Loop Rd, Va Medical Center (679/11), Tuscaloosa, AL 35404-5015 | 2006-01-04 |
| 1326046103 | Mark Nissenbaum | Orthopaedic Surgery | 1841 Huntingdon Pike, Huntingdon Valley, PA 19006-7712 | 2005-07-14 |
| Street Address |
200 BOYLSTON ST SUITE 305 |
| City | CHESTNUT HILL |
| State | MA |
| Zip Code | 02467-2012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760485015 | Jeffrey Clyde Sacks | Oral & Maxillofacial Surgery | 200 Boylston St, Suite 305, Chestnut Hill, MA 02467-2012 | 2005-05-31 |
| 1457860082 | Amelia Nodell | Physical Therapist | 200 Boylston St, Chestnut Hill, MA 02467-2012 | 2017-09-27 |
| 1124547088 | Danielle Nugent | Physical Medicine & Rehabilitation | 200 Boylston St, Chestnut Hill, MA 02467-2012 | 2017-09-12 |
| 1578933859 | Neras LLC | Surgery | 200 Boylston St, Suite 315, Chestnut Hill, MA 02467-2012 | 2015-09-30 |
| 1730556788 | Laura Jean Ladner | Nurse Practitioner | 200 Boylston St, 4th Floor, Chestnut Hill, MA 02467-2012 | 2015-08-25 |
| 1639562903 | Completendocrine LLC | Clinic/Center | 200 Boylston St, Suite 301, Chestnut Hill, MA 02467-2012 | 2015-03-11 |
| 1568871481 | Chestnut Hill Plastic and Aesthetic Surgery Associates, LLC | Surgery | 200 Boylston St, Suite # 307, Chestnut Hill, MA 02467-2012 | 2014-08-05 |
| 1790104263 | Wegmans Food Markets, Inc. | Pharmacy | 200 Boylston St, Chestnut Hill, MA 02467-2012 | 2014-04-14 |
| 1568880110 | Beth Israel Deaconess Medical Center, Inc | Clinic/Center | 200 Boylston St, Chestnut Hill, MA 02467-2012 | 2014-04-01 |
| 1891118873 | Personalized Medical Care LLC | Internal Medicine | 200 Boylston St, Suite 311, Chestnut Hill, MA 02467-2012 | 2014-01-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013542810 | Joanne L. Faber | Nurse Practitioner | 136 Beverly Road, Chestnut Hill, MA 02467 | 2020-03-12 |
| 1992338859 | Kim Elizabeth Chaplain | Physical Therapy Assistant | 615 Heath Street, Chestnut Hill, Ma. 02467, Chestnut Hill, MA 02467 | 2020-02-19 |
| 1407325251 | Tara Paulauskas | Social Worker | 791 Hammond St, Chestnut Hill, MA 02467 | 2018-11-21 |
| 1932684776 | Jeannine Kremer | Social Worker | 140 Commonweakth Ave, Chestnut Hill, MA 02467 | 2018-09-27 |
| 1639671563 | Kathleen Houlihan | Social Worker | Boston College Campus School - Campion 197, 140 Commonwealth Ave, Chestnut Hill, MA 02467 | 2018-03-07 |
| 1609374891 | The Counseling Center At Cela | Counselor | 675 Vfw Parkway #271, Chestnut Hill, MA 02467 | 2018-01-23 |
| 1033566328 | Boston Body Evolution LLC | Specialist | 1290 Boylston Street, Chestnut Hill, MA 02467 | 2016-05-17 |
| 1669827630 | Mikayla Wynter | Counselor | 393 Hammond St, Chestnut Hill, MA 02467 | 2016-04-27 |
| 1043697675 | Accurate Care Afc, Inc. | Home Health | 50/56 Broadlawn Park, Apt 506, Chestnut Hill, MA 02467 | 2015-05-04 |
| 1609285360 | Oba LLC | Anesthesiology | 6 Eliot Crescent, Brookline, MA 02467 | 2014-08-07 |
| Find all providers in zip 02467 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760485015 | Jeffrey Clyde Sacks | Oral & Maxillofacial Surgery | 200 Boylston St, Suite 305, Chestnut Hill, MA 02467-2012 | 2005-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518452705 | Yisi D Ji | Oral & Maxillofacial Surgery | 165 Cambridge St Ste 401, Mgh Dental Group, Boston, MA 02114-2750 | 2018-06-29 |
| 1013219476 | Karim E . Berty Dmd Md PC | Oral & Maxillofacial Surgery | 100 Amesbury St Ste 112, Lawrence, MA 01840-1321 | 2010-11-17 |
| 1457587065 | Zachary Scott Peacock | Oral & Maxillofacial Surgery | 55 Fruit Street, Warren 1201, Boston, MA 02114-2621 | 2009-06-10 |
| 1851580708 | Basim Jamal | Oral & Maxillofacial Surgery | 820 Harrison Ave, Fgh Building 4th Floor, Boston, MA 02118-2905 | 2007-10-16 |
| 1780875336 | Paul E Tesone Dds | Oral & Maxillofacial Surgery | One Centre Street, Malden, MA 02148 | 2007-08-08 |
| 1477679157 | Facial & Oral Surgery, LLC. | Oral & Maxillofacial Surgery | 17 N Washington St, North Attleboro, MA 02760-1605 | 2007-03-22 |
| 1003954504 | Timothy S Colton Dds PC | Oral & Maxillofacial Surgery | 164 Washington St, Suite 102, Norwell, MA 02061 | 2007-02-05 |
| 1609970268 | Brett Culver Denhart | Oral & Maxillofacial Surgery | 1066 Granby Road, Chicopee, MA 01020 | 2006-09-12 |
| 1265447965 | Edward T Lahey IIi | Oral & Maxillofacial Surgery | 15 Parkman St Wac 230, Oral & Maxillofacial Surgery, Boston, MA 02114 | 2006-07-30 |
| 1558382572 | Connecticut Valley Oral Surgery Associates, PC | Oral & Maxillofacial Surgery | 243 King St, Suite 101, Northampton, MA 01060-2451 | 2006-07-23 |
| Find all providers with the same taxonomy | ||||
| City | CHESTNUT HILL |
| Zip Code | 02467 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.