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Organization
JORGE BONILLA MD PC
Active
Organization
JORGE BONILLA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE BONILLA MD (MD)
(631) 608-4741
Entity
Organization
Contact information
Practice address
191 W HOFFMAN AVE, LINDENHURST, NY 11757-4036
(631) 608-4741
(631) 608-4742
Mailing address
116 BROADWAY STE 1, AMITYVILLE, NY 11701-2797
(631) 608-4741
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264692
LICENSE
NY
Enumeration date
05/17/2019
Last updated
08/15/2023
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