MEDICARE: FILOMENA BUNCKE, NP PSYCHIATRY PC

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
1	103TB0200X	Cognitive & Behavioral Psychologist	F400357-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306911748	OTHER	NY	NPI

General Provider Information

NPI Number	:	1851612162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FILOMENA BUNCKE, NP PSYCHIATRY PC

Provider Business Mailing Address
First Line	:	140 BELLEMEADE RD
Second Line	:	SUITE A
City	:	SETAUKET
State	:	NY
Zip	:	11733-6400
Country	:	US
Telephone Number	:	631-689-5390
Fax Number	:	631-689-5395

Provider Business Practice Location Address
First Line	:	140 BELLEMEADE RD
Second Line	:	SUITE A
City	:	SETAUKET
State	:	NY
Zip	:	11733-6400
Country	:	US
Telephone Number	:	631-689-5390
Fax Number	:	631-689-5395

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. TONI ANN SCOLLO
Credential	:
Telephone Number	:	631-689-5390

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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