Healthcare Provider Details

I. General information

NPI: 1063833432
Provider Name (Legal Business Name): MRS. KRISTINE MARIE BUSCAGLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HINSDALE AVE
FLORAL PARK NY
11001-1501
US

IV. Provider business mailing address

29 HINSDALE AVE
FLORAL PARK NY
11001-1501
US

V. Phone/Fax

Practice location:
  • Phone: 631-514-9892
  • Fax:
Mailing address:
  • Phone: 631-514-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number461701
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number461701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: