Healthcare Provider Details

I. General information

NPI: 1699309302
Provider Name (Legal Business Name): JOEY BUKAI PMHNP-BC, LMHC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 5TH AVE STE 1103
NEW YORK NY
10001-3604
US

IV. Provider business mailing address

418 BROADWAY STE 4279
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 937-756-6697
  • Fax:
Mailing address:
  • Phone: 937-756-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012686
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407127
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: