Provider Demographics
NPI:1699527713
Name:DA JOSE, DANIELLA JEAN BUNTOG (DPT)
Entity type:Individual
Prefix:
First Name:DANIELLA JEAN
Middle Name:BUNTOG
Last Name:DA JOSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 TIBBETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3708
Mailing Address - Country:US
Mailing Address - Phone:929-536-5542
Mailing Address - Fax:
Practice Address - Street 1:3409 TIBBETT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3708
Practice Address - Country:US
Practice Address - Phone:929-536-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044317208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation