Healthcare Provider Details

I. General information

NPI: 1013367408
Provider Name (Legal Business Name): PHILIP BUZZERIO M.S. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 GIANTS DR
EAST RUTHERFORD NJ
07073-2140
US

IV. Provider business mailing address

27 ADDISON AVE
RUTHERFORD NJ
07070-2303
US

V. Phone/Fax

Practice location:
  • Phone: 201-403-1513
  • Fax:
Mailing address:
  • Phone: 201-403-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000016993
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: