Provider Demographics
NPI:1508189903
Name:BAUTISTA, ABELEN
Entity Type:Individual
Prefix:
First Name:ABELEN
Middle Name:
Last Name:BAUTISTA
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 1:55 KARNELL DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5748
Mailing Address - Country:US
Mailing Address - Phone:732-317-4874
Mailing Address - Fax:
Practice Address - Street 1:55 KARNELL DR
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5748
Practice Address - Country:US
Practice Address - Phone:732-317-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042771-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist