Individual
MR. MICHAEL HENRY BOLUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
451 CLARKSON AVE, BROOKLYN, NY 11203-2054
(718) 245-3131
Mailing address
1113 E 73RD ST, BROOKLYN, NY 11234-5400
(718) 763-5633
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401420
NY
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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