Provider Demographics
NPI:1043988413
Name:BABULA, MICHAEL S (FNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BABULA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 DE PEYSTER AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5209
Mailing Address - Country:US
Mailing Address - Phone:315-794-5430
Mailing Address - Fax:
Practice Address - Street 1:1001 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4400
Practice Address - Country:US
Practice Address - Phone:315-624-9471
Practice Address - Fax:315-922-9502
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily