MEDICARE: PHILIP BUZZERIO M.S. ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2000016993

General Provider Information

NPI Number	:	1013367408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP BUZZERIO M.S. ATC

Provider Business Mailing Address
First Line	:	27 ADDISON AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2303
Country	:	US
Telephone Number	:	201-403-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 GIANTS DR
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-2140
Country	:	US
Telephone Number	:	201-403-1513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/03/2021

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