Healthcare Provider Details

I. General information

NPI: 1528398062
Provider Name (Legal Business Name): MARIA STEPHANIE GBUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 193RD ST
BRONX NY
10458-4710
US

IV. Provider business mailing address

16 OAKRIDGE PL
EASTCHESTER NY
10709-2013
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-2400
  • Fax:
Mailing address:
  • Phone: 914-337-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: