Provider Demographics
NPI:1588610893
Name:BULY, ROBERT LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEON
Last Name:BULY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3832
Mailing Address - Country:US
Mailing Address - Phone:914-834-7506
Mailing Address - Fax:914-834-1295
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:212-606-1971
Practice Address - Fax:212-742-0497
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist