Individual
DR. JOHN RICHARD BULOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21 PINION PINE LN, QUEENSBURY, NY 12804-9012
(518) 743-9758
Mailing address
21 PINION PINE LN, QUEENSBURY, NY 12804-9012
(518) 743-9758
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
120304
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120304
NYS LICENSE
NY
Enumeration date
01/30/2006
Last updated
09/04/2025
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