Basic Information
| Provider Information | |||||||||
| NPI: | 1740222868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCOBO | ||||||||
| FirstName: | YOLEIDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BOHORQUEZ | ||||||||
| OtherFirstName: | YOLEIDA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 441 9TH AVENUE | ||||||||
| Address2: | CREDENTIALING OFFICE - 3RD FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100012139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466802894 | ||||||||
| FaxNumber: | 5165425556 | ||||||||
| Practice Location | |||||||||
| Address1: | 546 EASTERN PARKWAY | ||||||||
| Address2: | EMPIRE CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186044800 | ||||||||
| FaxNumber: | 7186044828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 1868721 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.