Provider Demographics
NPI:1932258076
Name:MARTY, BONNIE (RN)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:MARTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SAW MILL RIVER RD
Mailing Address - Street 2:ARCS
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1535
Mailing Address - Country:US
Mailing Address - Phone:914-345-8888
Mailing Address - Fax:
Practice Address - Street 1:40 SAW MILL RIVER RD
Practice Address - Street 2:ARCS
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1535
Practice Address - Country:US
Practice Address - Phone:914-345-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177005-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200741OtherHEALTHNET
NY400177005NY01OtherANTHEM
NYR49031Medicare UPIN
NY200741OtherHEALTHNET