Provider Demographics
NPI:1730612169
Name:BHULAI, TEJKUMAR
Entity type:Individual
Prefix:MR
First Name:TEJKUMAR
Middle Name:
Last Name:BHULAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11117 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1344
Mailing Address - Country:US
Mailing Address - Phone:718-738-0620
Mailing Address - Fax:718-738-0621
Practice Address - Street 1:11117 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1344
Practice Address - Country:US
Practice Address - Phone:718-738-0620
Practice Address - Fax:718-738-0621
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY55009857156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician