Healthcare Provider Details

I. General information

NPI: 1013492545
Provider Name (Legal Business Name): BERNICE BOUZY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 E MAIN ST
PATCHOGUE NY
11772-3145
US

IV. Provider business mailing address

14 SHELLEY CIR
EAST WINDSOR NJ
08520-4684
US

V. Phone/Fax

Practice location:
  • Phone: 631-866-2030
  • Fax:
Mailing address:
  • Phone: 407-284-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: