Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 022930 | NY |
NPI | 1003390865 |
---|---|
Provider Name | Dr. George Richard Bulger |
First Address | Staten Island, NY 10308-1603 |
Second Address | Brooklyn, NY 11206-2580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 18/09/2018 |