Provider Demographics
NPI:1356449011
Name:BULNES, VICTOR MANUEL (PA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MANUEL
Last Name:BULNES
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:571 ACADEMY ST
Mailing Address - Street 2:GLE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5104
Mailing Address - Country:US
Mailing Address - Phone:212-567-0550
Mailing Address - Fax:212-567-6574
Practice Address - Street 1:571 ACADEMY ST
Practice Address - Street 2:GLE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5104
Practice Address - Country:US
Practice Address - Phone:212-567-0550
Practice Address - Fax:212-567-6574
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid