Provider Demographics
NPI:1508906777
Name:METROPOLITAN NEW YORK MEDICINE & INFECTIOUS DISEASES, P.C.
Entity Type:Organization
Organization Name:METROPOLITAN NEW YORK MEDICINE & INFECTIOUS DISEASES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:TADEO
Authorized Official - Last Name:BONOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-338-7534
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-0351
Mailing Address - Country:US
Mailing Address - Phone:914-338-7534
Mailing Address - Fax:914-338-7537
Practice Address - Street 1:337 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3032
Practice Address - Country:US
Practice Address - Phone:914-338-7534
Practice Address - Fax:914-338-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202436207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N81758OtherHEALTHNET
NY2512720OtherGHI
2813319OtherAETNA
NY202436OtherHIP
NY2X0703OtherEMPIRE BLUE CROSS BLUE SH
P00033933OtherRAILROAD MEDICARE
P2579806OtherOXFORD
NY02957495Medicaid
NY2X0703OtherEMPIRE BLUE CROSS BLUE SH
NY202436OtherHIP