Healthcare Provider Details

I. General information

NPI: 1316227010
Provider Name (Legal Business Name): PIERRE BONTUYAN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 07/20/2026
Certification Date:
Deactivation Date: 08/14/2012
Reactivation Date: 07/20/2026

III. Provider practice location address

2215 CROPSEY AVE APT. D7
BROOKLYN NY
11214-5645
US

IV. Provider business mailing address

2215 CROPSEY AVE APT. D7
BROOKLYN NY
11214-5645
US

V. Phone/Fax

Practice location:
  • Phone: 347-312-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number292625-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: