Provider Demographics
NPI:1942277660
Name:BUNGAY, KRISCZAR J (MD)
Entity Type:Individual
Prefix:
First Name:KRISCZAR
Middle Name:J
Last Name:BUNGAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:BUNGAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:314 W 14TH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:212-620-0144
Mailing Address - Fax:212-691-8588
Practice Address - Street 1:314 W 14TH ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014
Practice Address - Country:US
Practice Address - Phone:212-620-0144
Practice Address - Fax:212-691-8588
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02420006Medicaid
H99830Medicare UPIN
129AU1Medicare ID - Type Unspecified