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General NPI Number Information
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NPI Number | 1275819104
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Entity Type | Individual
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Provider Name | JOEL M BUMOL M.D
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Gender | Male
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 3011 BOSTON RD
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City | BRONX
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State | NY
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Zip | 10469-4002
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Country | US
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Telephone | 718-547-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 3544 JEROME AVE
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City | BRONX
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State | NY
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Zip | 10467-1005
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Country | US
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Telephone | 187-920-5521
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 274694
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License Number State | NY
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