Basic Information
| Provider Information | |||||||||
| NPI: | 1134625353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULAEVSKY | ||||||||
| FirstName: | INNA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4422 3RD AVE | ||||||||
| Address2: | BRAKER BUILDING, 4TH FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189606240 | ||||||||
| FaxNumber: | 7189606125 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 N MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109601912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453482000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 346249 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.