Provider Demographics
NPI:1265757876
Name:BUSS, MARIO (PA-C)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:BUSS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:155 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1139
Mailing Address - Country:US
Mailing Address - Phone:908-721-2318
Mailing Address - Fax:
Practice Address - Street 1:318 CHRIS GAUPP DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4460
Practice Address - Country:US
Practice Address - Phone:609-404-9900
Practice Address - Fax:609-404-3653
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2018-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY013933363A00000X
NJ25MP00424100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant