Individual
ELLEN BUCOBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1275 YORK AVE, NEW YORK, NY 10065-6007
(212) 639-2024
Mailing address
1275 YORK AVE, NEW YORK, NY 10065-6007
(212) 639-2024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011440
NY
363AS0400X
Surgical Physician Assistant
PA20222
CA
Other
Enumeration date
01/25/2007
Last updated
03/11/2020
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