Healthcare Provider Details

I. General information

NPI: 1699235648
Provider Name (Legal Business Name): WILLIAM IVAN BUNIAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 W TAFT RD STE H
LIVERPOOL NY
13088-4991
US

IV. Provider business mailing address

5112 W TAFT RD STE H
LIVERPOOL NY
13088-4991
US

V. Phone/Fax

Practice location:
  • Phone: 315-410-7499
  • Fax: 315-410-7490
Mailing address:
  • Phone: 315-452-3235
  • Fax: 315-452-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number337198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: