Provider Demographics
NPI:1730379488
Name:MARIA L BUNAG MEDICAL P C
Entity type:Organization
Organization Name:MARIA L BUNAG MEDICAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:BUNAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-702-2507
Mailing Address - Street 1:1111 TARGEE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4323
Mailing Address - Country:US
Mailing Address - Phone:718-702-2507
Mailing Address - Fax:718-447-6654
Practice Address - Street 1:1111 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4323
Practice Address - Country:US
Practice Address - Phone:718-702-2507
Practice Address - Fax:718-447-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE04006Medicare UPIN