Provider Demographics
NPI:1235427022
Name:MARY RUTH BUCHNESS MD DERMATOLOGIST PC
Entity Type:Organization
Organization Name:MARY RUTH BUCHNESS MD DERMATOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYRUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-822-3515
Mailing Address - Street 1:560 BROADWAY RM 406
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3946
Mailing Address - Country:US
Mailing Address - Phone:212-822-3515
Mailing Address - Fax:
Practice Address - Street 1:560 BROADWAY RM 406
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3946
Practice Address - Country:US
Practice Address - Phone:212-822-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156839261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E49772Medicare UPIN