Provider Demographics
NPI:1326192170
Name:BUSILLO, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:BUSILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:111 BROADWAY
Mailing Address - Street 2:2ND FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1901
Mailing Address - Country:US
Mailing Address - Phone:212-263-9700
Mailing Address - Fax:212-263-9701
Practice Address - Street 1:111 BROADWAY
Practice Address - Street 2:2ND FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1901
Practice Address - Country:US
Practice Address - Phone:212-263-9700
Practice Address - Fax:212-263-9701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2021-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY179207207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY179207OtherLICENSE