Provider Demographics
NPI:1013396654
Name:BUKALA, MAGDALENA
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:BUKALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BARSTOW RD
Mailing Address - Street 2:SUITE P-20
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3540
Mailing Address - Country:US
Mailing Address - Phone:516-441-5255
Mailing Address - Fax:516-570-2291
Practice Address - Street 1:1 BARSTOW RD
Practice Address - Street 2:SUITE P-20
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3540
Practice Address - Country:US
Practice Address - Phone:516-441-5255
Practice Address - Fax:516-570-2291
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000792103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst