Provider Demographics
NPI:1629735352
Name:BUSTAMANTE, CARMEN Y
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:Y
Last Name:BUSTAMANTE
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 1:56 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2618
Mailing Address - Country:US
Mailing Address - Phone:201-317-1236
Mailing Address - Fax:
Practice Address - Street 1:56 JAMES ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2618
Practice Address - Country:US
Practice Address - Phone:201-317-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)