Provider Demographics
NPI:1770655094
Name:DORU BUZA MD
Entity type:Organization
Organization Name:DORU BUZA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DORU
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-628-1010
Mailing Address - Street 1:6083 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5908
Mailing Address - Country:US
Mailing Address - Phone:718-628-1010
Mailing Address - Fax:
Practice Address - Street 1:6083 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5908
Practice Address - Country:US
Practice Address - Phone:718-628-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01491670Medicaid
NY01267Medicare ID - Type Unspecified
NY01491670Medicaid
NY60J933Medicare ID - Type Unspecified