Healthcare Provider Details

I. General information

NPI: 1578109526
Provider Name (Legal Business Name): LAURA BUZOVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORPORATE BLVD S
YONKERS NY
10701-6862
US

IV. Provider business mailing address

954 BALCOM AVE
BRONX NY
10465-1924
US

V. Phone/Fax

Practice location:
  • Phone: 914-294-6300
  • Fax:
Mailing address:
  • Phone: 347-372-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number780164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: