Healthcare Provider Details

I. General information

NPI: 1386673424
Provider Name (Legal Business Name): BORA GUMUSTOP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 WASHINGTON AVE SUITE 101
ALBANY NY
12206-1056
US

IV. Provider business mailing address

1375 WASHINGTON AVE SUITE 101
ALBANY NY
12206-1056
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-4483
  • Fax: 518-482-4201
Mailing address:
  • Phone: 518-438-4483
  • Fax: 518-482-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number220804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: