Provider Demographics
NPI:1265757496
Name:JONATHAN D BONIUK MD PC
Entity type:Organization
Organization Name:JONATHAN D BONIUK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-432-2299
Mailing Address - Street 1:2717 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4806
Mailing Address - Country:US
Mailing Address - Phone:718-432-2299
Mailing Address - Fax:718-432-2069
Practice Address - Street 1:3333 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 1K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3235
Practice Address - Country:US
Practice Address - Phone:718-432-2299
Practice Address - Fax:718-432-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199677207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01592070Medicaid
NYG06339Medicare UPIN