Provider Demographics
NPI:1811129562
Name:BOCCHIERI-BUSTROS, ELISA (DO)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:BOCCHIERI-BUSTROS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 2ND AVE
Mailing Address - Street 2:APT 9D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5329
Mailing Address - Country:US
Mailing Address - Phone:516-455-8507
Mailing Address - Fax:
Practice Address - Street 1:3 BARKER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1509
Practice Address - Country:US
Practice Address - Phone:914-949-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine