MEDICARE: MR. LEONARDO DANAN BULURAN 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	225100000X	Physical Therapist	053767	NY

General Provider Information

NPI Number	:	1891504544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEONARDO DANAN BULURAN PT

Provider Business Mailing Address
First Line	:	5186 MANILLA ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4151
Country	:	US
Telephone Number	:	831-521-2989
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 BEACH 116TH ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2102
Country	:	US
Telephone Number	:	718-474-2224
Fax Number	:

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

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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