Healthcare Provider Details

I. General information

NPI: 1811307788
Provider Name (Legal Business Name): JEFFREY DAVID BUZIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 HOLME AVE
PHILADELPHIA PA
19136-1830
US

IV. Provider business mailing address

1761 JUNIPER CIR
JAMISON PA
18929-1408
US

V. Phone/Fax

Practice location:
  • Phone: 215-992-1861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022931
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: