Healthcare Provider Details

I. General information

NPI: 1235282583
Provider Name (Legal Business Name): ANGELA BUZZEO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 BROADWAY
NEW YORK NY
10019-1412
US

IV. Provider business mailing address

1790 BROADWAY
NEW YORK NY
10019-1412
US

V. Phone/Fax

Practice location:
  • Phone: 203-532-9330
  • Fax:
Mailing address:
  • Phone: 203-532-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR47715
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number002286
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License Number349003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: