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General NPI Number Information
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NPI Number | 1558469601
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Entity Type | Individual
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Provider Name | MARIE ROSE BURGONIO BHUIYAN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 9020 191ST ST
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City | HOLLIS
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State | NY
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Zip | 11423-2518
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Country | US
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Telephone | 718-721-3523
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Fax |
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Provider Business Mailing Address
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Address Line | 301 COVERT AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-5436
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Country | US
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Telephone | 516-352-3771
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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 | F401016-1
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License Number State | NY
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