Individual
JALAL UD-DIN BUKHARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
53 BETTY ANN DR, SOUTH SETAUKET, NY 11720-1043
(631) 355-9371
Mailing address
36 BALSAM DR, HICKSVILLE, NY 11801-2051
(631) 355-9371
Taxonomy
Speciality
Code
Description
License number
State
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
060812
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97664419F45226
—
CA
Enumeration date
04/28/2017
Last updated
10/03/2019
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