Provider Demographics
NPI:1558968354
Name:BOLUSI, DANAMARIE
Entity Type:Individual
Prefix:
First Name:DANAMARIE
Middle Name:
Last Name:BOLUSI
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 1:134 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1207
Mailing Address - Country:US
Mailing Address - Phone:917-756-3700
Mailing Address - Fax:
Practice Address - Street 1:134 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1207
Practice Address - Country:US
Practice Address - Phone:917-756-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist