Provider Demographics
NPI:1205872082
Name:BUENAHORA, JOSEPH ALBERT (DPM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALBERT
Last Name:BUENAHORA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003848-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T51247Medicare UPIN
NYP40671Medicare PIN