Provider Demographics
NPI:1639341100
Name:JOSEPH ALBERT BUENAHORA
Entity Type:Organization
Organization Name:JOSEPH ALBERT BUENAHORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BUENAHORA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-679-1338
Mailing Address - Street 1:477 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4121
Mailing Address - Country:US
Mailing Address - Phone:516-679-1338
Mailing Address - Fax:516-679-2759
Practice Address - Street 1:477 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4121
Practice Address - Country:US
Practice Address - Phone:516-679-1338
Practice Address - Fax:516-679-2759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH BUENAHORA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003848-1332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4113560001Medicare NSC