Basic Information
| Provider Information | |||||||||
| NPI: | 1013949932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOBBY | ||||||||
| FirstName: | JUNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SUK | ||||||||
| OtherFirstName: | JUENA | ||||||||
| OtherMiddleName: | J. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4 BRIAR CLOSE RD | ||||||||
| Address2: | |||||||||
| City: | LARCHMONT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105381009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162555700 | ||||||||
| FaxNumber: | 8666182917 | ||||||||
| Practice Location | |||||||||
| Address1: | 134 NORTH CHATSWORTH AVE | ||||||||
| Address2: | |||||||||
| City: | LARCHMONT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105381651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127942500 | ||||||||
| FaxNumber: | 2128793846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 05/24/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 210146 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 102375743 0001 | 05 | PA | MEDICAID | 1477044 | 05 | LA | MEDICAID | 2932054 | 05 | OH | MEDICAID | 913809755 | 01 | TRICARE NORTH | OTHER | 932T81 | 01 | NY | BCBS | OTHER | P00971897 | 01 | NY | RXR MCR | OTHER | 932T01 | 01 | NY | BCBS | OTHER | 01906243 | 05 | NY | MEDICAID |