Provider Demographics
NPI:1649270893
Name:BONK, EDWARD C (CRNA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:C
Last Name:BONK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY403605-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
9691728OtherGHI
R6B57OtherEMPIRE BLUE CROSS
X00000OtherAMERICAN PROGRESSIVE TODA
4123054OtherMVP
33588YOtherFIDELIS MEDICARE
000494072001OtherBLUE SHIELD OF NENY
10002421OtherCDPHP
403605-1OtherTRICARE NORTH REGION
9691728OtherGHI
33588YMedicare ID - Type Unspecified