Provider Demographics
NPI:1073300406
Name:BUSIELLO, DENISE HELENA
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:HELENA
Last Name:BUSIELLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LAUREL TRL
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-2413
Mailing Address - Country:US
Mailing Address - Phone:631-504-8045
Mailing Address - Fax:
Practice Address - Street 1:300 PANTIGO PL STE 112
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5927
Practice Address - Country:US
Practice Address - Phone:631-504-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008074225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant