Provider Demographics
NPI:1134325442
Name:SILVA, RAYMOND BUKALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:BUKALAN
Last Name:SILVA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 187TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1827
Mailing Address - Country:US
Mailing Address - Phone:917-478-7564
Mailing Address - Fax:
Practice Address - Street 1:370 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3153
Practice Address - Country:US
Practice Address - Phone:718-224-9094
Practice Address - Fax:718-748-2884
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist