Provider Demographics
NPI:1982959714
Name:BULGAKOV, VALERIY
Entity Type:Individual
Prefix:MR
First Name:VALERIY
Middle Name:
Last Name:BULGAKOV
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 1:1461 SHORE PKWY
Mailing Address - Street 2:2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6146
Mailing Address - Country:US
Mailing Address - Phone:646-262-9623
Mailing Address - Fax:
Practice Address - Street 1:1461 SHORE PKWY
Practice Address - Street 2:2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6131
Practice Address - Country:US
Practice Address - Phone:646-262-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist