Provider Demographics
NPI:1881774537
Name:BUMATAY, JOSEPH TAGUPA (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TAGUPA
Last Name:BUMATAY
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 1:16918 UNION TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-380-4700
Mailing Address - Fax:718-380-4834
Practice Address - Street 1:16918 UNION TURNPIKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:718-380-4700
Practice Address - Fax:718-380-4834
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132920207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603443Medicaid
B13279Medicare UPIN
04480Medicare ID - Type Unspecified