Healthcare Provider Details

I. General information

NPI: 1699040816
Provider Name (Legal Business Name): NICHOLAS VINCENT BUSCEMI MSOM LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW SUITE 402
WASHINGTON DC
20015-2014
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW SUITE 402
WASHINGTON DC
20015-2014
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-7000
  • Fax: 202-237-0017
Mailing address:
  • Phone: 202-237-7000
  • Fax: 202-237-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC500143
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: