Healthcare Provider Details

I. General information

NPI: 1063420057
Provider Name (Legal Business Name): GREGORY CHARLES BUNT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 WEST 40TH STREET
NEW YORK NY
10018
US

IV. Provider business mailing address

611 PALMER ROAD
YONKERS NY
10701
US

V. Phone/Fax

Practice location:
  • Phone: 212-354-6000
  • Fax: 212-391-9265
Mailing address:
  • Phone: 212-354-6000
  • Fax: 212-391-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number1585551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: