MEDICARE: LATOSHIA BULLOCK M.D.

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	207P00000X	Emergency Medicine Physician	305402	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942664032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOSHIA BULLOCK M.D.

Provider Business Mailing Address
First Line	:	1 GUSTAVE L LEVY PL # 1149
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:	212-824-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL # 1149
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:	212-824-8069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	02/24/2026

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