Healthcare Provider Details

I. General information

NPI: 1497675706
Provider Name (Legal Business Name): EMILY ROSE BUNKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 UPPER FRONT ST
BINGHAMTON NY
13901-1046
US

IV. Provider business mailing address

33 LEWIS RD
BINGHAMTON NY
13905-1048
US

V. Phone/Fax

Practice location:
  • Phone: 607-722-3417
  • Fax:
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: