Provider Demographics
NPI:1093199978
Name:BUNNING, EMILY F (LAC, MSTOM)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:F
Last Name:BUNNING
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 15TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8708
Mailing Address - Country:US
Mailing Address - Phone:917-749-2909
Mailing Address - Fax:
Practice Address - Street 1:511 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4971
Practice Address - Country:US
Practice Address - Phone:917-749-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004630171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist