Provider Demographics
NPI:1730757311
Name:OUT EAST MEDICAL
Entity type:Organization
Organization Name:OUT EAST MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-385-3700
Mailing Address - Street 1:1027 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5245
Mailing Address - Country:US
Mailing Address - Phone:212-385-3700
Mailing Address - Fax:
Practice Address - Street 1:3531 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5700
Practice Address - Country:US
Practice Address - Phone:212-385-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOBBY BUKA, M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty