Provider Demographics
NPI:1912496332
Name:MURPHY, BONNIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SALISBURY MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12577-0008
Mailing Address - Country:US
Mailing Address - Phone:954-815-6713
Mailing Address - Fax:
Practice Address - Street 1:448 TEMPLE HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5510
Practice Address - Country:US
Practice Address - Phone:845-500-1985
Practice Address - Fax:845-522-8888
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021992363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical