Provider Demographics
NPI:1851612162
Name:FILOMENA BUNCKE, NP PSYCHIATRY PC
Entity Type:Organization
Organization Name:FILOMENA BUNCKE, NP PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-689-5390
Mailing Address - Street 1:140 BELLEMEADE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6400
Mailing Address - Country:US
Mailing Address - Phone:631-689-5390
Mailing Address - Fax:631-689-5395
Practice Address - Street 1:140 BELLEMEADE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6400
Practice Address - Country:US
Practice Address - Phone:631-689-5390
Practice Address - Fax:631-689-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400357-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1306911748OtherNPI