Individual
JOHNNY BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
191 PATCHOGUE YAPHANK RD, EAST PATCHOGUE, NY 11772-4899
(516) 551-4722
(631) 475-0975
Mailing address
191 PATCHOGUE YAPHANK RD, EAST PATCHOGUE, NY 11772-4899
(516) 551-4722
(631) 475-0975
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
045343-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045343-01
NYS PT LICENSE
NY
Enumeration date
01/23/2020
Last updated
01/24/2020
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