Healthcare Provider Details

I. General information

NPI: 1992505226
Provider Name (Legal Business Name): JENNIFER BUSCH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 NORTHERN BLVD STE 203
GREAT NECK NY
11021-5310
US

IV. Provider business mailing address

865 NORTHERN BLVD STE 203
GREAT NECK NY
11021-5310
US

V. Phone/Fax

Practice location:
  • Phone: 516-708-2540
  • Fax: 516-708-2573
Mailing address:
  • Phone: 516-708-2540
  • Fax: 516-708-2573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF355861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: