Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 289804 | NY |
NPI | 1235574435 |
---|---|
Provider Name | Stephanie Swensen Buza |
First Address | New York, NY 10087-9234 |
Second Address | New York, NY 10021-4871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 17/12/2020 |