Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MB03778600 | NJ |
NPI | 1770507337 |
---|---|
Provider Name | Scott L Busch |
First Address | Cherry Hill, NJ 08003-2136 |
Second Address | Cherry Hill, NJ 08003-2136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 12/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3392406 | (05) | NJ |
C54303 | (02) | NJ |