Provider Demographics
NPI:1508983545
Name:BHOLA, EWA
Entity Type:Individual
Prefix:MS
First Name:EWA
Middle Name:
Last Name:BHOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EWA
Other - Middle Name:
Other - Last Name:ZDUNCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2142 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4142
Mailing Address - Country:US
Mailing Address - Phone:718-819-6803
Mailing Address - Fax:
Practice Address - Street 1:1160 MONTAUK HWY
Practice Address - Street 2:BOTTOM LEVEL
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-4904
Practice Address - Country:US
Practice Address - Phone:631-842-4606
Practice Address - Fax:631-842-0803
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare PIN