Provider Demographics
NPI:1891282414
Name:BONTZOS, ELENI
Entity Type:Individual
Prefix:MS
First Name:ELENI
Middle Name:
Last Name:BONTZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 HARLAN LN
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7559
Mailing Address - Country:US
Mailing Address - Phone:443-812-6500
Mailing Address - Fax:
Practice Address - Street 1:7151 HARLAN LN
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7559
Practice Address - Country:US
Practice Address - Phone:443-812-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133N00000X, 390200000X
MDW513822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program