Provider Demographics
NPI:1093438319
Name:BONQUIN, EPIFANIA
Entity Type:Individual
Prefix:
First Name:EPIFANIA
Middle Name:
Last Name:BONQUIN
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 1:367 E 204TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4701
Mailing Address - Country:US
Mailing Address - Phone:914-481-9465
Mailing Address - Fax:
Practice Address - Street 1:367 E 204TH ST APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4701
Practice Address - Country:US
Practice Address - Phone:914-481-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY87-2427910Medicaid