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Individual

IRINEO BUSTAMANTE JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1925 PACIFIC AVE, ATLANTIC CITY, NJ 08401-6713
(609) 345-4000
Mailing address
6896 W SNOWVILLE RD, BRECKSVILLE, OH 44141-3214
(440) 717-6600

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MA04155400
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0212820000
AMERIHEALTH
NJ
01
30035362
KEYSTONE MERCY
NJ
05
3987302
NJ
01
60018849
HORIZON NJ HEALTH
NJ
01
P00312204
RAILROAD MEDICARE
NJ
Enumeration date
08/28/2006
Last updated
03/07/2023
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