Individual
DR. EDWARD BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-6604
Mailing address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
333352
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2021
Last updated
10/23/2024
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