Individual
BEN JAY BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
355 GRAND ST, JERSEY CITY, NJ 07302-4321
(201) 915-2000
Mailing address
76 GRIECO DR, JERSEY CITY, NJ 07305-4898
(201) 467-6970
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
26NJ01186000
NJ
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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