Provider Demographics
NPI:1841568524
Name:BONHOMME, MARJORIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:BONHOMME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:BONHOMME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:522 ALICIA DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1311
Mailing Address - Country:US
Mailing Address - Phone:502-767-2420
Mailing Address - Fax:
Practice Address - Street 1:522 ALICIA DR
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1311
Practice Address - Country:US
Practice Address - Phone:502-767-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBONHM1247ZC0005X
CADRH 102247ZC0005X
CAMTC 742247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician