Healthcare Provider Details

I. General information

NPI: 1467155028
Provider Name (Legal Business Name): MS. ELIZABETH BUFFAMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 BELLE TERRE RD BLDG J
PORT JEFFERSON NY
11777-1936
US

IV. Provider business mailing address

53 JOHN ST APT 2
BABYLON NY
11702-2929
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-5361
  • Fax:
Mailing address:
  • Phone: 917-715-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number023944
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: