Individual ProviderBubu BaniniInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address40 Temple St Ste 1a, New Haven, CT 06510-2715(203) 688-4242PECOS EnrollmentBased on the most recent information from CMS, provider Bubu Banini is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:14 PM.Profile DetailsProvider ID1427320985Provider TypeIndividualFull NameBanini, BubuTitleDr.CredentialMD PHDGenderFemaleSole ProprietorNoEnumeration Date1/30/2012Last Updated7/16/2020Contact InformationPractice LocationPractice Address40 Temple St Ste 1a, New Haven, CT 06510-2715Phone(203) 688-4242FaxUnlisted FaxMailing LocationMailing Address40 Temple St Ste 1a, New Haven, CT 06510-2715PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense330642New YorkCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense57517MinnesotaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID66395DescriptionOtherIssuerCONNECTICUT PHYSICIAN LICENSEConnecticut