Provider Demographics
NPI:1720202435
Name:KURTZ, BONNIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:KIMCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 E 77TH ST
Mailing Address - Street 2:4FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1851
Mailing Address - Country:US
Mailing Address - Phone:212-434-3222
Mailing Address - Fax:212-434-2837
Practice Address - Street 1:130 E 77TH ST
Practice Address - Street 2:4FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1851
Practice Address - Country:US
Practice Address - Phone:212-434-3222
Practice Address - Fax:212-434-2837
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant