Healthcare Provider Details

I. General information

NPI: 1366811994
Provider Name (Legal Business Name): JAN MICHAEL BUMATAY PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MADISON ST
NEW YORK NY
10002-7537
US

IV. Provider business mailing address

227 E MADISON AVE
DUMONT NJ
07628-2537
US

V. Phone/Fax

Practice location:
  • Phone: 212-238-7103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: