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General NPI Number Information
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NPI Number | 1073300406
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Entity Type | Individual
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Provider Name | DENISE HELENA BUSIELLO
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Gender |
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 300 PANTIGO PL STE 112
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City | EAST HAMPTON
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State | NY
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Zip | 11937-5927
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Country | US
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Telephone | 631-504-8045
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LAUREL TRL
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City | SAG HARBOR
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State | NY
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Zip | 11963-2413
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Country | US
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Telephone | 631-504-8045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 008074
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License Number State | NY
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