1679539266 NPI number — DR. MIHAI BUSUIOC OD

Table of content: DR. MIHAI BUSUIOC OD (NPI 1679539266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679539266 NPI number — DR. MIHAI BUSUIOC OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSUIOC
Provider First Name:
MIHAI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679539266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 DOUGLAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12775-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-707-4628
Provider Business Mailing Address Fax Number:
845-796-3938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
343 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12701-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-796-3937
Provider Business Practice Location Address Fax Number:
845-796-3938
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00594500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: TUV006743-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0052752 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52949 . This is a "DAVIS VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 28597 . This is a "SPECTERA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 02529959 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: NY6743 . This is a "COLE VISIONEYEMED" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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