Basic Information
| Provider Information | |||||||||
| NPI: | 1477899359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULAUITAN | ||||||||
| FirstName: | CONSTANTINE | ||||||||
| MiddleName: | SPYRIDAKIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 ROUTE 33 | ||||||||
| Address2: | AKERMAN BLD 4 TRAUMA DEPARTMENT | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327764949 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1945 ROUTE 33 | ||||||||
| Address2: | AKERMAN BLD 4 TRAUMA DEPARTMENT | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327764949 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2012 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA09490400 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.