Healthcare Provider Details

I. General information

NPI: 1487186573
Provider Name (Legal Business Name): RIZA BUESER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 06/18/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 NEW HYDE PARK RD
NEW HYDE PARK NY
11042-1209
US

IV. Provider business mailing address

38 KNIGHTSBRIDGE RD APT 2K
GREAT NECK NY
11021-4523
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-6100
  • Fax:
Mailing address:
  • Phone: 551-265-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number310142-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: