Provider Demographics
NPI:1184667487
Name:BONDI, ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:BONDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BROOKDALE PLZ STE 666
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-5236
Mailing Address - Fax:718-240-5808
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:RM 107 AARON
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5236
Practice Address - Fax:718-240-6592
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112576207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00203916Medicaid
NY291741Medicare ID - Type Unspecified
NY00203916Medicaid