Individual
ELIZABETH BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
301 E MAIN ST BLDG 217, BAY SHORE, NY 11706-8408
(631) 968-3683
Mailing address
6 EASTERN PKWY, FARMINGDALE, NY 11735-2650
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
308333
NY
Other
Enumeration date
08/02/2017
Last updated
08/02/2017
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