Provider Demographics
NPI:1902212376
Name:BONSU, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BONSU
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 1:800 CONCOURSE VLG W
Mailing Address - Street 2:16D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3607
Mailing Address - Country:US
Mailing Address - Phone:347-886-4855
Mailing Address - Fax:
Practice Address - Street 1:800 CONCOURSE VLG W
Practice Address - Street 2:16D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3607
Practice Address - Country:US
Practice Address - Phone:347-886-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-091184171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor