Provider Demographics
NPI:1013949932
Name:BOBBY, JUNA (MD)
Entity Type:Individual
Prefix:
First Name:JUNA
Middle Name:
Last Name:BOBBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUENA
Other - Middle Name:J
Other - Last Name:SUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 BRIAR CLOSE RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1009
Mailing Address - Country:US
Mailing Address - Phone:216-255-5700
Mailing Address - Fax:866-618-2917
Practice Address - Street 1:134 NORTH CHATSWORTH AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1651
Practice Address - Country:US
Practice Address - Phone:212-794-2500
Practice Address - Fax:212-879-3846
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2101462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102375743 0001Medicaid
LA1477044Medicaid
OH2932054Medicaid
913809755OtherTRICARE NORTH
NY932T81OtherBCBS
NYP00971897OtherRXR MCR
NY932T01OtherBCBS
NY01906243Medicaid
NYP00971897OtherRXR MCR
LA1477044Medicaid
NY01906243Medicaid
NYA400050818Medicare PIN