Provider Demographics
NPI:1144334699
Name:BUKHMAN, LEONID (MD)
Entity type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:BUKHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEXINGTON AVE
Mailing Address - Street 2:SUITE 21H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2256 2ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2202
Practice Address - Country:US
Practice Address - Phone:212-758-7777
Practice Address - Fax:212-858-0657
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635427Medicaid
NYH12788Medicare UPIN
NY17V141Medicare ID - Type Unspecified