Provider Demographics
NPI:1912720145
Name:BUNZE, KRISTEN IRIS
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:IRIS
Last Name:BUNZE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:IRIS
Other - Last Name:KROENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2209
Mailing Address - Country:US
Mailing Address - Phone:631-434-5583
Mailing Address - Fax:
Practice Address - Street 1:19 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2209
Practice Address - Country:US
Practice Address - Phone:631-434-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1220377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist