Provider Demographics
NPI:1205191764
Name:THOMAS HUNTT, BONNIE DOREEN (MED)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:DOREEN
Last Name:THOMAS HUNTT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W 119TH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1210
Mailing Address - Country:US
Mailing Address - Phone:917-375-5154
Mailing Address - Fax:
Practice Address - Street 1:208 W 119TH ST APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1210
Practice Address - Country:US
Practice Address - Phone:917-375-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist