Healthcare Provider Details

I. General information

NPI: 1255243499
Provider Name (Legal Business Name): ETHAN STROUSE VAN BUSKIRK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

IV. Provider business mailing address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8772
  • Fax:
Mailing address:
  • Phone: 717-231-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: