Provider Demographics
NPI:1710044599
Name:BUSCEMI, LIBBY (MD)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:
Last Name:BUSCEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5159
Mailing Address - Country:US
Mailing Address - Phone:212-734-7546
Mailing Address - Fax:212-734-2496
Practice Address - Street 1:176 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5159
Practice Address - Country:US
Practice Address - Phone:212-734-7546
Practice Address - Fax:212-734-2496
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212372207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H57354Medicare UPIN
NY1K1031Medicare ID - Type Unspecified