Provider Demographics
NPI:1053200659
Name:FOK, BONITA Y
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:Y
Last Name:FOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COLD HARBOUR LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2408
Mailing Address - Country:US
Mailing Address - Phone:917-873-7823
Mailing Address - Fax:
Practice Address - Street 1:5 COLD HARBOUR LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2408
Practice Address - Country:US
Practice Address - Phone:917-873-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator