Provider Demographics
NPI:1205849395
Name:BUCHNESS, MARY RUTH (MD)
Entity Type:Individual
Prefix:
First Name:MARY RUTH
Middle Name:
Last Name:BUCHNESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CROSBY ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4715
Mailing Address - Country:US
Mailing Address - Phone:917-974-8501
Mailing Address - Fax:888-317-8328
Practice Address - Street 1:160 W 26TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6975
Practice Address - Country:US
Practice Address - Phone:646-660-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156839207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB046F4010Medicare ID - Type Unspecified
E49772Medicare UPIN