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General NPI Number Information
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NPI Number | 1376379446
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Entity Type | Individual
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Provider Name | JESSE TAYLOR BUA PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 175 JERICHO TPKE STE 216
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City | SYOSSET
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State | NY
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Zip | 11791-4538
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Country | US
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Telephone | 844-443-2563
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Fax |
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Provider Business Mailing Address
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Address Line | 315 ATLANTIC AVE APT 2P
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1103
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Country | US
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Telephone | 516-330-7724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F407602-01
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License Number State | NY
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