Basic Information
| Provider Information | |||||||||
| NPI: | 1952589814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSAPAVANIJ | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112118767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123853700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 152 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112118767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123853700 | ||||||||
| FaxNumber: | 2123853703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2008 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 012317 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.