Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 135038 | NY |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 135038 | NY |
NPI | 1063509156 |
---|---|
Provider Name | James B Bussel |
First Address | New York, NY 10021-4870 |
Second Address | New York, NY 10021-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 14/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0658017 | (05) | NY |
B19137 | (02) | NY |