Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 045766 | NY |
NPI | 1154913226 |
---|---|
Provider Name | Bryan Buenafe |
First Address | Jamaica, NY 11432-2770 |
Second Address | Jamaica, NY 11432-2770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 09/02/2021 |