Provider Demographics
NPI:1821831215
Name:MAGAT, DEAN ANTONIO BULATAO (MD)
Entity type:Individual
Prefix:
First Name:DEAN ANTONIO
Middle Name:BULATAO
Last Name:MAGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 JONES ST APT 331
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3842
Mailing Address - Country:US
Mailing Address - Phone:610-417-0731
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST # UHI-248
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program