Provider Demographics
NPI:1902517923
Name:BUSCAGLIA, KERRI ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANNE
Last Name:BUSCAGLIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3305
Mailing Address - Country:US
Mailing Address - Phone:732-221-3934
Mailing Address - Fax:
Practice Address - Street 1:40 BEY LEA RD STE C203
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2974
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00415200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty