Provider Demographics
NPI:1225812787
Name:BUSOG, BLESSIE MAE MADUCDOC (PT)
Entity Type:Individual
Prefix:
First Name:BLESSIE MAE
Middle Name:MADUCDOC
Last Name:BUSOG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6515 38TH AVE APT 6G
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2907
Mailing Address - Country:US
Mailing Address - Phone:908-627-9229
Mailing Address - Fax:
Practice Address - Street 1:8046 KEW GARDENS RD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1154
Practice Address - Country:US
Practice Address - Phone:718-261-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist