Healthcare Provider Details

I. General information

NPI: 1316948680
Provider Name (Legal Business Name): NAGI J BUSTROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 4TH AVE FL 2
BROOKLYN NY
11220-5350
US

IV. Provider business mailing address

217 OVINGTON AVE
BROOKLYN NY
11209-1204
US

V. Phone/Fax

Practice location:
  • Phone: 929-455-2740
  • Fax:
Mailing address:
  • Phone: 718-238-0098
  • Fax: 718-836-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number122979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: