Provider Demographics
NPI:1477947067
Name:BUNZE, SETH (LMT)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:
Last Name:BUNZE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4352
Mailing Address - Country:US
Mailing Address - Phone:631-745-0088
Mailing Address - Fax:631-580-1278
Practice Address - Street 1:4 HEWITT SQ
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2519
Practice Address - Country:US
Practice Address - Phone:516-982-4989
Practice Address - Fax:631-580-1278
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist