Healthcare Provider Details

I. General information

NPI: 1144942947
Provider Name (Legal Business Name): MICHELLE FRANCINE BUETI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 NASSAU BLVD S
GARDEN CITY NY
11530
US

IV. Provider business mailing address

122 WEST ST APT 2P
BROOKLYN NY
11222-1972
US

V. Phone/Fax

Practice location:
  • Phone: 516-208-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number043749-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: