Healthcare Provider Details

I. General information

NPI: 1437114345
Provider Name (Legal Business Name): TIM BUZY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 WASHINGTON AVE
OCEANSIDE NY
11572
US

IV. Provider business mailing address

3998 FAIR RIDGE DR SUITE 300
FAIRFAX VA
22033-2907
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-0946
  • Fax: 516-536-4495
Mailing address:
  • Phone: 703-295-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number219995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: