Healthcare Provider Details

I. General information

NPI: 1518526417
Provider Name (Legal Business Name): MICHAEL JOHN BUZZELL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 NORTHFIELD AVE
WEST ORANGE NJ
07052-2426
US

IV. Provider business mailing address

11 CATTANO AVE APT 309
MORRISTOWN NJ
07960-6843
US

V. Phone/Fax

Practice location:
  • Phone: 630-770-9513
  • Fax:
Mailing address:
  • Phone: 630-770-9513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: