Healthcare Provider Details

I. General information

NPI: 1801113279
Provider Name (Legal Business Name): BILIKISU BHADMUS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 VICTORY BLVD
STATEN ISLAND NY
10314-3550
US

IV. Provider business mailing address

224 OSGOOD AVE
STATEN ISLAND NY
10304-3603
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0781
  • Fax:
Mailing address:
  • Phone: 718-801-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: