Provider Demographics
NPI:1568570919
Name:VANBUSKIRK, STACEY J (PA)
Entity Type:Individual
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First Name:STACEY
Middle Name:J
Last Name:VANBUSKIRK
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Gender:F
Credentials:PA
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Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-736-1500
Mailing Address - Fax:518-762-8194
Practice Address - Street 1:23 S PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2316
Practice Address - Country:US
Practice Address - Phone:518-736-1500
Practice Address - Fax:518-762-8194
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2021-08-31
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Provider Licenses
StateLicense IDTaxonomies
NY005851363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1568570919OtherBSH NE NY
NY351792OtherMVP HEALTH CARE
NY1568570919OtherBSH NE NY
NYP30080Medicare UPIN