Healthcare Provider Details

I. General information

NPI: 1144334699
Provider Name (Legal Business Name): LEONID BUKHMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2256 2ND AVE FL 2
NEW YORK NY
10029-2202
US

IV. Provider business mailing address

50 LEXINGTON AVE SUITE 21H
NEW YORK NY
10010-2935
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-7777
  • Fax: 212-858-0657
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number216806
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: