Bouklas, George James

Bouklas, George James is an sole proprietor health care provider with primary practice located at 69A Gnarled Hollow Rd , East Setauket NY 11733-2026. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Bouklas, George James can be contacted via phone (631) 751-0092.

Contact Information

Primary practice address
69A Gnarled Hollow Rd East Setauket NY 11733-2026
Phone: (631) 751-0092
Fax: (631) 689-6201
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 011248 New York

Profile Details

NPI number 1891834305
LBN Legal business name Bouklas, George James
Credentials PH.D
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 5th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891834305 NPPES
New York MEDICAID 01338949

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