Provider Demographics
NPI:1730679549
Name:BUK, ANI (MA, LP, LCAT)
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:BUK
Suffix:
Gender:F
Credentials:MA, LP, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 86TH ST # 19E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3410
Mailing Address - Country:US
Mailing Address - Phone:646-391-4266
Mailing Address - Fax:
Practice Address - Street 1:161 W. 86 ST
Practice Address - Street 2:SUITE 1AW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3411
Practice Address - Country:US
Practice Address - Phone:212-560-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000558-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst