Provider Demographics
NPI:1396097358
Name:BULAK, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BULAK
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 1:67 WHITESBORO ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13495-1313
Mailing Address - Country:US
Mailing Address - Phone:315-266-3200
Mailing Address - Fax:
Practice Address - Street 1:6000 ROUTE 291
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403
Practice Address - Country:US
Practice Address - Phone:315-266-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY521315163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool