Provider Demographics
NPI:1073856167
Name:BONDOC, JAY BEE G
Entity Type:Individual
Prefix:
First Name:JAY BEE
Middle Name:G
Last Name:BONDOC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12512 135TH AVE # 2F
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3208
Mailing Address - Country:US
Mailing Address - Phone:347-341-0772
Mailing Address - Fax:
Practice Address - Street 1:12512 135TH AVE # 2F
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3208
Practice Address - Country:US
Practice Address - Phone:347-341-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1415737235Z00000X
NY1590946222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist