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General NPI Number Information
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NPI Number | 1710915418
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Entity Type | Organization
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Legal Business Name | MANUEL BULAUITAN
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 17706 WEXFORD TER
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City | JAMAICA
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State | NY
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Zip | 11432-2927
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Country | US
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Telephone | 718-291-9384
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Fax |
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Provider Business Mailing Address
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Address Line | 17706 WEXFORD TER
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City | JAMAICA
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State | NY
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Zip | 11432-2927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | MANUEL BULAUITAN
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Credential |
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Telephone | 718-291-9384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 121369
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License Number State | NY
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