Healthcare Provider Details

I. General information

NPI: 1407853724
Provider Name (Legal Business Name): PAUL FREDERIC BUSMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 5TH AVE
TROY NY
12180-3302
US

IV. Provider business mailing address

12 CHARLES ST
COHOES NY
12047-4108
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-6881
  • Fax: 518-272-6866
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN002738
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: