Provider Demographics
NPI:1447239082
Name:BOLANTE, MENELIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MENELIO
Middle Name:
Last Name:BOLANTE
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:PO BOX 140458
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0458
Mailing Address - Country:US
Mailing Address - Phone:718-979-9623
Mailing Address - Fax:718-980-0628
Practice Address - Street 1:800 MANOR RD STE 7
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7030
Practice Address - Country:US
Practice Address - Phone:718-979-9623
Practice Address - Fax:718-980-0628
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123738207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00651276Medicaid
NY37A262Medicare ID - Type Unspecified
NY00651276Medicaid