Provider Demographics
NPI:1578702809
Name:BUNQUE, MARIA LOURDES G (NP)
Entity Type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:G
Last Name:BUNQUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIA LOURDES
Other - Middle Name:G
Other - Last Name:REYES GAMBOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5901 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1205
Mailing Address - Country:US
Mailing Address - Phone:718-581-1625
Mailing Address - Fax:
Practice Address - Street 1:5901 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1205
Practice Address - Country:US
Practice Address - Phone:718-581-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY463490-1163W00000X
NYF340603363LG0600X
NY404577363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology