Healthcare Provider Details

I. General information

NPI: 1326790742
Provider Name (Legal Business Name): ASHIMATU BUKARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 LINDEN AVE
JERSEY CITY NJ
07305-2616
US

IV. Provider business mailing address

185 LINDEN AVE
JERSEY CITY NJ
07305-2616
US

V. Phone/Fax

Practice location:
  • Phone: 201-238-6460
  • Fax:
Mailing address:
  • Phone: 201-238-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number775702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: