Provider Demographics
NPI:1740486885
Name:BONDER, JACLYN H (MD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:H
Last Name:BONDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:LESLIE
Other - Last Name:HALPERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:BAKER PAVILION 16TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-1500
Mailing Address - Fax:212-746-8303
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BAKER PAVILION 16TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-1500
Practice Address - Fax:212-746-8303
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY247339208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program