Individual
MS. MARIETTA BUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
727 BROADWAY, MASSAPEQUA, NY 11758
(516) 799-0210
Mailing address
22 MCALPIN AVE, ALBERTSON, NY 11507-1908
(516) 799-0210
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
009628
NY
Other
Enumeration date
11/06/2006
Last updated
07/08/2007
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