Provider Demographics
NPI:1104975143
Name:BUCOBO, EMIGDIO A (MD)
Entity type:Individual
Prefix:
First Name:EMIGDIO
Middle Name:A
Last Name:BUCOBO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:345 SCHERMERHORN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1025
Mailing Address - Country:US
Mailing Address - Phone:718-403-3547
Mailing Address - Fax:718-858-0145
Practice Address - Street 1:233 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4924
Practice Address - Country:US
Practice Address - Phone:718-826-5900
Practice Address - Fax:718-826-5906
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY120179208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB18814Medicare UPIN