Healthcare Provider Details

I. General information

NPI: 1093479982
Provider Name (Legal Business Name): ISABEL MARIE BUSTAMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 60TH ST FL 5
NEW YORK NY
10022-1694
US

IV. Provider business mailing address

110 E 60TH ST FL 5
NEW YORK NY
10022-1694
US

V. Phone/Fax

Practice location:
  • Phone: 646-502-5450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF347778
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: