Healthcare Provider Details

I. General information

NPI: 1659350965
Provider Name (Legal Business Name): CRISTINA ALCID BUMATAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 PITKIN AVE
BROOKLYN NY
11207
US

IV. Provider business mailing address

6 ALOGATE DR W
MANHASSET NY
11030
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-0480
  • Fax: 718-240-0558
Mailing address:
  • Phone: 718-240-0480
  • Fax: 718-240-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number144879
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: