Provider Demographics
NPI:1912141276
Name:BUNIMOVICH, YURI
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:
Last Name:BUNIMOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 NORTHWOOD DR
Mailing Address - Street 2:SHADYSIDE PLACE, SUITE 200-202
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 NORTHWOOD DR
Practice Address - Street 2:SHADYSIDE PLACE, SUITE 200-202
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3882
Practice Address - Country:US
Practice Address - Phone:310-980-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454598390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program