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NPI Code Detail

MEDICARE: DR. EVGENY BULAT MD, MA

MEDICARE: DR. EVGENY BULAT MD, MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) Physician328362-01NY
2208VP0014XInterventional Pain Medicine Physician328362-01NY

General Provider Information

NPI Number : 1659832509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EVGENY BULAT MD, MA
Provider Business Mailing Address
First Line : 290 MADISON AVE STE 201
Second Line :
City : NEW YORK
State : NY
Zip : 10017-6308
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 350 JERICHO TPKE STE 310
Second Line :
City : JERICHO
State : NY
Zip : 11753-1317
Country : US
Telephone Number : 212-470-6676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2019
Last Update Date : 02/18/2025

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