Provider Demographics
NPI:1225340714
Name:BANUSKI, JAMIE
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:BANUSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 GEORGE WASHINGTON MEM HWY
Mailing Address - Street 2:PMB511
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692
Mailing Address - Country:US
Mailing Address - Phone:757-303-8900
Mailing Address - Fax:
Practice Address - Street 1:7307 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:PMB511
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692
Practice Address - Country:US
Practice Address - Phone:757-303-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable