Provider Demographics
NPI:1821757139
Name:BUEN, DIEGO (DPT)
Entity Type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:
Last Name:BUEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 80TH ST STE 8210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7733
Mailing Address - Country:US
Mailing Address - Phone:516-365-2063
Mailing Address - Fax:516-365-2060
Practice Address - Street 1:7119 80TH ST STE 8210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7733
Practice Address - Country:US
Practice Address - Phone:516-365-2063
Practice Address - Fax:516-365-2060
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty