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Ivy Bullock
NPI 1023496718 · on the registry since 2015
Practice
- Address
- 240 Long Island Ave
Wyandanch, NY 11798 - Phone
- (631) 782-6200
- Fax
- (631) 491-5354
- Clinicians at this address
- 25
Registry record
- Primary taxonomy
- 104100000X
104100000X
- Licence states on file
- NY
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2022-06-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York