Healthcare Provider Details

I. General information

NPI: 1205102886
Provider Name (Legal Business Name): JOHN JASON BULIYAT RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ZELLER DR
SOMERSET NJ
08873-7335
US

IV. Provider business mailing address

59 ZELLER DRIVE
SOMERSET NJ
08873
US

V. Phone/Fax

Practice location:
  • Phone: 732-568-1450
  • Fax:
Mailing address:
  • Phone: 732-568-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number103086
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: