MEDICARE: ELIZABETH BUKAC MS, RD, CDN, CDCES

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	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	86069323	NY

General Provider Information

NPI Number	:	1639867344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BUKAC MS, RD, CDN, CDCES

Provider Business Mailing Address
First Line	:	6029 DELAFIELD AVE APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6029 DELAFIELD AVE APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1801
Country	:	US
Telephone Number	:	917-916-5454
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	09/13/2024

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