Provider Demographics
NPI:1437221702
Name:BONFILS-ROBERTS, ENRIQUE AUGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:AUGUSTO
Last Name:BONFILS-ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 CHARLES ST
Mailing Address - Street 2:18-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3011
Mailing Address - Country:US
Mailing Address - Phone:212-675-8422
Mailing Address - Fax:718-579-4620
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:620
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5900
Practice Address - Fax:718-579-4620
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY111161208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00199202Medicaid
NY00199202Medicaid