Provider Demographics
NPI:1689975690
Name:BONILLA MARTIR, MIGDALIA ZOE (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGDALIA
Middle Name:ZOE
Last Name:BONILLA MARTIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 MOORE AVE STE LR
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3100
Mailing Address - Country:US
Mailing Address - Phone:914-218-8188
Mailing Address - Fax:914-218-8189
Practice Address - Street 1:15 MOORE AVE STE LR
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3100
Practice Address - Country:US
Practice Address - Phone:914-218-8188
Practice Address - Fax:914-218-8189
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09414500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0285846Medicaid
NJ0394807Medicaid