Individual
STEPHANUS BUSONO
Active
Individual
STEPHANUS BUSONO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MA069235
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2342811
AETNA
NJ
01
—
P1626374
OXFORD
NJ
Enumeration date
06/11/2006
Last updated
12/03/2018
Update your record
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