Individual
HENDA BOUALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4417 VESTAL PARKWAY EAST, SUITE 202, VESTAL, NY 13850-3556
(607) 770-7365
(607) 729-5882
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2580
(607) 729-8156
(607) 729-3982
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
246796
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02940054
—
NY
Enumeration date
10/24/2006
Last updated
09/19/2012
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