# LEO VIGNE MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LEO VIGNE MD PC, LEO VIGNE MD PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497237036
- **Authorized official:** DR. LEO GARY BONILLA JR. MD (PRESIDENT)
- **Authorized official phone:** (347) 374-0554

## Contact information

- **Practice address:** 106 W 105TH ST APT 16, NEW YORK, NY 10025-8802
- **Practice address phone:** (917) 733-0344
- **Mailing address:** 106 W 105TH ST APT 16, NEW YORK, NY 10025-8802
- **Mailing address phone:** (917) 733-0344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 207239-1 | NY | Yes |

## Other

- **Enumeration date:** 08/30/2018
- **Last updated:** 01/04/2024