Provider Demographics
NPI:1164748158
Name:BUSOVSKY-MCNEAL, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:BUSOVSKY-MCNEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:BUSOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:160 E 32ND ST
Mailing Address - Street 2:L-3 MEDICAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6004
Mailing Address - Country:US
Mailing Address - Phone:212-263-5940
Mailing Address - Fax:212-263-5808
Practice Address - Street 1:160 E 32ND ST
Practice Address - Street 2:L-3 MEDICAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6004
Practice Address - Country:US
Practice Address - Phone:212-263-5940
Practice Address - Fax:212-263-5808
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246873-1208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03233841Medicaid