Provider Demographics
NPI:1740222868
Name:BUCOBO, YOLEIDA (MD)
Entity Type:Individual
Prefix:
First Name:YOLEIDA
Middle Name:
Last Name:BUCOBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YOLEIDA
Other - Middle Name:
Other - Last Name:BOHORQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:441 9TH AVENUE
Mailing Address - Street 2:CREDENTIALING OFFICE - 3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2139
Mailing Address - Country:US
Mailing Address - Phone:646-680-2894
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:546 EASTERN PARKWAY
Practice Address - Street 2:EMPIRE CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:718-604-4800
Practice Address - Fax:718-604-4828
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1868721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400021401Medicare PIN