Healthcare Provider Details

I. General information

NPI: 1174502751
Provider Name (Legal Business Name): DEBBIE P. BAUTISTA-HUSSEY D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBBIE P. BAUTISTA D.P.M.

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 E 149TH ST SUITE 216
BRONX NY
10455-3907
US

IV. Provider business mailing address

185 HOBART ST
PEARL RIVER NY
10965-1838
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-7081
  • Fax:
Mailing address:
  • Phone: 646-251-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: