Healthcare Provider Details

I. General information

NPI: 1548947625
Provider Name (Legal Business Name): JULIUS DELANTAR BAUTISTA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9244 213TH ST
QUEENS VILLAGE NY
11428-1123
US

IV. Provider business mailing address

9244 213TH ST
QUEENS VILLAGE NY
11428-1123
US

V. Phone/Fax

Practice location:
  • Phone: 516-312-8377
  • Fax:
Mailing address:
  • Phone: 516-312-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP122239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: