Provider Demographics
NPI:1689697039
Name:BUNIN, JESSICA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:BUNIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1033 ETHAN ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5006
Mailing Address - Country:US
Mailing Address - Phone:301-404-7467
Mailing Address - Fax:845-787-4221
Practice Address - Street 1:8901 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-1109
Practice Address - Country:US
Practice Address - Phone:301-295-4000
Practice Address - Fax:845-938-5770
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01055120A2084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN
NY33025FMedicare ID - Type Unspecified