Provider Demographics
NPI:1558705954
Name:BUSUTTIL, NEIL EDGAR SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:EDGAR
Last Name:BUSUTTIL
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 55TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1518
Mailing Address - Country:US
Mailing Address - Phone:917-288-7424
Mailing Address - Fax:
Practice Address - Street 1:3128 55TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1518
Practice Address - Country:US
Practice Address - Phone:917-288-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist