Healthcare Provider Details

I. General information

NPI: 1609204783
Provider Name (Legal Business Name): MS. MARILOU ABARQUEZ BUENVIAJE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILOU ABARQUEZ BUENVIAJE LPN

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VAN PELT AVE
STATEN ISLAND NY
10303-2435
US

IV. Provider business mailing address

300 VAN PELT AVE
STATEN ISLAND NY
10303-2435
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-5904
  • Fax:
Mailing address:
  • Phone: 718-720-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: