Provider Demographics
NPI:1043593940
Name:BUZIASHVILI, IRAKLII (MD)
Entity Type:Individual
Prefix:DR
First Name:IRAKLII
Middle Name:
Last Name:BUZIASHVILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 BRIGHTON 3RD ST
Mailing Address - Street 2:#401
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6897
Mailing Address - Country:US
Mailing Address - Phone:718-975-3833
Mailing Address - Fax:718-975-3836
Practice Address - Street 1:2952 BRIGHTON 3RD ST
Practice Address - Street 2:#401
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6897
Practice Address - Country:US
Practice Address - Phone:718-975-3833
Practice Address - Fax:718-975-3836
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263080207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism