Healthcare Provider Details

I. General information

NPI: 1275819104
Provider Name (Legal Business Name): JOEL M BUMOL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 BOSTON RD
BRONX NY
10469-4002
US

IV. Provider business mailing address

3544 JEROME AVE
BRONX NY
10467-1005
US

V. Phone/Fax

Practice location:
  • Phone: 718-547-6111
  • Fax:
Mailing address:
  • Phone: 187-920-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number274694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: