MEDICARE: DR. GERARD BUSACCO DC

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	111N00000X	Chiropractor	38MC00517300	NJ

General Provider Information

NPI Number	:	1336332352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD BUSACCO DC

Provider Business Mailing Address
First Line	:	518 79TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4929
Country	:	US
Telephone Number	:	201-758-1001
Fax Number	:	201-758-1091

Provider Business Practice Location Address
First Line	:	518 79TH STREET
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5344
Country	:	US
Telephone Number	:	201-758-1001
Fax Number	:	201-758-1091

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	06/24/2008

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Directions to “ DR. GERARD BUSACCO DC” Practice Location

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