Healthcare Provider Details

I. General information

NPI: 1568477081
Provider Name (Legal Business Name): MARY ELAINE E BUENCONSEJO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 JOHN ST SUITE 1445
NEW YORK NY
10038-3101
US

IV. Provider business mailing address

15 PARK ROW #15J
NEW YORK NY
10038-2301
US

V. Phone/Fax

Practice location:
  • Phone: 212-571-4800
  • Fax:
Mailing address:
  • Phone: 212-571-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023922-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: