Provider Demographics
NPI:1093791469
Name:BONDARCHUK, THOMAS A (NP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:BONDARCHUK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1084 CROMWELL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3445
Mailing Address - Country:US
Mailing Address - Phone:860-780-2002
Mailing Address - Fax:860-257-0147
Practice Address - Street 1:1084 CROMWELL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3445
Practice Address - Country:US
Practice Address - Phone:860-780-2002
Practice Address - Fax:860-257-0147
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY483389363L00000X
CT003246363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health