Healthcare Provider Details

I. General information

NPI: 1023374196
Provider Name (Legal Business Name): HEATHER JEANNINE BUSICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 07/06/2023
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 CULVER RD
ROCHESTER NY
14609
US

IV. Provider business mailing address

905 CULVER RD
ROCHESTER NY
14609-7115
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-7900
  • Fax: 585-288-1381
Mailing address:
  • Phone: 585-276-7900
  • Fax: 585-288-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number279024
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number279024
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number279024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: