Numerical simulations and experiments have been carried out to investigate the effect of fuel injection nozzles on the combustion and NOx formation processes in a medium-speed marine diesel engine. Spray visualization experiment was performed in the constant-volume high-pressure chamber to verify the numerical results on the spray characteristics such as spray angle and spray tip penetration. Time-resolved spray behaviors were captured by high-speed digital camera and analyzed to extract the information on the spray parameters. Spray and combustion phenomena were examined numerically using FIRE code. Wave breakup and Zeldovich models were adopted to describe the atomization characteristics and NOx formation processes. Numerical results were verified with experimental data such as cylinder pressure, heat release rate and NOx emission. Finally, the effects of fuel injection nozzles on the engine performance were investigated numerically to find the optimum nozzle parameters such as fuel injection angle, nozzle hole diameter and number of nozzle holes. From this study, the optimum fuel injection nozzle (nozzle hole diameter, 0.32 mm, number of nozzle holes, 8 and fuel injection angle, $148^{circ}$) was selected to reduce both the fuel consumption and NOx emission. The reason for this selection could be explained from the highest fuel-air mixing in the early phase of injection due to the longest spray tip penetration and the highest heat release rate after $19^{circ}$ ATDC due to the increased injection duration.