MEDICARE: MR. RAYMOND BUKALAN SILVA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	023235	NY

General Provider Information

NPI Number	:	1134325442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND BUKALAN SILVA PT

Provider Business Mailing Address
First Line	:	8911 187TH ST
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-1827
Country	:	US
Telephone Number	:	917-478-7564
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3153
Country	:	US
Telephone Number	:	718-224-9094
Fax Number	:	718-748-2884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2007
Last Update Date	:	07/08/2007

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