Healthcare Provider Details

I. General information

NPI: 1639867344
Provider Name (Legal Business Name): ELIZABETH BUKAC MS, RD, CDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 DELAFIELD AVE APT 2
BRONX NY
10471-1801
US

IV. Provider business mailing address

6029 DELAFIELD AVE APT 2
BRONX NY
10471-1801
US

V. Phone/Fax

Practice location:
  • Phone: 917-916-5454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86069323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: