Provider Demographics
NPI:1982761375
Name:BULANOV, TATIANA (PT)
Entity Type:Individual
Prefix:MISS
First Name:TATIANA
Middle Name:
Last Name:BULANOV
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5011
Mailing Address - Country:US
Mailing Address - Phone:917-882-0550
Mailing Address - Fax:
Practice Address - Street 1:2148 OCEAN AVE STE 301
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1406
Practice Address - Country:US
Practice Address - Phone:718-872-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020707-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020707-1OtherSTATE LICENSE