Healthcare Provider Details

I. General information

NPI: 1932944055
Provider Name (Legal Business Name): BISOU MEDICAL ARTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 06/29/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WALL ST # 2360
NEW YORK NY
10005-4301
US

IV. Provider business mailing address

99 WALL ST # 2360
NEW YORK NY
10005-4301
US

V. Phone/Fax

Practice location:
  • Phone: 646-591-8046
  • Fax:
Mailing address:
  • Phone: 646-591-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AIDA BOUNAMA
Title or Position: OWNER
Credential: M.D.
Phone: 646-591-8046