Healthcare Provider Details

I. General information

NPI: 1770655094
Provider Name (Legal Business Name): DORU BUZA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6083 MYRTLE AVE
RIDGEWOOD NY
11385-5908
US

IV. Provider business mailing address

6083 MYRTLE AVE
RIDGEWOOD NY
11385-5908
US

V. Phone/Fax

Practice location:
  • Phone: 718-628-1010
  • Fax:
Mailing address:
  • Phone: 718-628-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number194378
License Number StateNY

VIII. Authorized Official

Name: DORU BUZA
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 718-628-1010