Provider Demographics
NPI:1649216367
Name:BOURLA, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:BOURLA
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 1:4277 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5709
Mailing Address - Country:US
Mailing Address - Phone:516-731-7770
Mailing Address - Fax:516-731-7052
Practice Address - Street 1:789 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4907
Practice Address - Country:US
Practice Address - Phone:516-433-3600
Practice Address - Fax:516-433-9490
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128336207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00887036Medicaid
NYAS530OtherOXFORD
NY1C4996OtherHEALTHNET
NY1C4996OtherHEALTHNET
NY56A031Medicare ID - Type Unspecified