Provider Demographics
NPI:1841627353
Name:BONELLI, BAOKIM NGUYEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BAOKIM
Middle Name:NGUYEN
Last Name:BONELLI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:26 FIREMANS MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:800-750-8616
Mailing Address - Fax:845-362-8474
Practice Address - Street 1:214 SULLIVAN ST
Practice Address - Street 2:SUITE/APT #
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1354
Practice Address - Country:US
Practice Address - Phone:212-385-3700
Practice Address - Fax:212-385-3703
Is Sole Proprietor?:No
Enumeration Date:2013-09-28
Last Update Date:2017-02-22
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Provider Licenses
StateLicense IDTaxonomies
NY017064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant