Provider Demographics
NPI:1730448044
Name:BUNCHE, ANTOINETTE S (MS)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:S
Last Name:BUNCHE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 PITMAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1918
Mailing Address - Country:US
Mailing Address - Phone:347-964-7752
Mailing Address - Fax:
Practice Address - Street 1:2015 PITMAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1918
Practice Address - Country:US
Practice Address - Phone:347-964-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209041031174400000X
NY982771001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist