Provider Demographics
NPI:1356341424
Name:BUSSEY, PAUL G (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1025
Mailing Address - Country:US
Mailing Address - Phone:856-769-1669
Mailing Address - Fax:856-769-7959
Practice Address - Street 1:1 MILL ST
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1025
Practice Address - Country:US
Practice Address - Phone:856-769-1669
Practice Address - Fax:856-769-7959
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2015-09-02
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0778400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042978Medicaid
NJ083527S6VMedicare PIN
NJ0042978Medicaid
NJI16929Medicare UPIN