ELIOT M NISSENBAUM DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

ACTIVE

Business

Title

First Name

ELIOT

Middle

Last Name

NISSENBAUM

Business Name

ELIOT M NISSENBAUM DO

Original Issue Date

07/17/2014

Effective Date

07/17/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/17/2023