Individual
EDUARDO R BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 DAVIS AVE FL 7, NEPTUNE, NJ 07753-4488
(732) 776-4524
(732) 776-4639
Mailing address
19 DAVIS AVE FL 7, NEPTUNE, NJ 07753-4488
(732) 776-4524
(732) 776-4639
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MA062854
NJ
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
25MA06285400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7856506
—
NJ
Enumeration date
02/13/2006
Last updated
11/11/2019
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