Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 246873-1 | NY |
Y | 2080P0202X | Pediatric Cardiologist | 246873-1 | NY |
NPI | 1164748158 |
---|---|
Provider Name | Melissa Anne Busovsky-Mcneal |
First Address | New York, NY 10016-6004 |
Second Address | New York, NY 10016-6004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03233841 | (05) | NY |