Healthcare Provider Details

I. General information

NPI: 1811237142
Provider Name (Legal Business Name): JOSE BUHAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2013
Last Update Date: 02/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 JUDSON AVE APT 5D
WOODBURY CT
06798-2844
US

IV. Provider business mailing address

19 JUDSON AVE APT 5D
WOODBURY CT
06798-2844
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-6422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number017977
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: