Provider Demographics
NPI:1164497236
Name:BUMSTEAD, BARBARA (NP-C, MSCN)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:BUMSTEAD
Suffix:
Gender:F
Credentials:NP-C, MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3620
Mailing Address - Country:US
Mailing Address - Phone:631-758-4444
Mailing Address - Fax:631-758-1984
Practice Address - Street 1:280 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8403
Practice Address - Country:US
Practice Address - Phone:631-758-4444
Practice Address - Fax:631-758-1984
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3027232084N0400X
NY302723363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02458139Medicaid
NYP26700Medicare UPIN
NY0E6051Medicare ID - Type Unspecified