Provider Demographics
NPI:1720067531
Name:BONAROS, ELIAS P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:P
Last Name:BONAROS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-327-0001
Mailing Address - Fax:516-326-9753
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:SUITE 411
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-327-0001
Practice Address - Fax:516-326-9753
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215605207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY566P81Medicare ID - Type Unspecified
NYI10961Medicare UPIN