Provider Demographics
NPI:1558800565
Name:BUSHATI, ALJON
Entity Type:Individual
Prefix:
First Name:ALJON
Middle Name:
Last Name:BUSHATI
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 1:6113 MENAHAN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2627
Mailing Address - Country:US
Mailing Address - Phone:347-206-3119
Mailing Address - Fax:
Practice Address - Street 1:6113 MENAHAN ST FL 2
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2627
Practice Address - Country:US
Practice Address - Phone:347-206-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000978742471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography