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General NPI Number Information
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NPI Number | 1730612169
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Entity Type | Individual
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Provider Name | MR. TEJKUMAR BHULAI
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Gender | Male
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 11117 LEFFERTS BLVD
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-1344
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Country | US
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Telephone | 718-738-0620
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Fax | 718-738-0621
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Provider Business Mailing Address
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Address Line | 11117 LEFFERTS BLVD
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-1344
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Country | US
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Telephone | 718-738-0620
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Fax | 718-738-0621
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 55009857
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License Number State | NY
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