Organization
LEO VIGNE MD PC
Active
Other names
LEO VIGNE MD PC, LEO VIGNE MD PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEO GARY BONILLA JR. MD (PRESIDENT)
(347) 374-0554
Entity
Organization
Contact information
Practice address
106 W 105TH ST APT 16, NEW YORK, NY 10025-8802
(917) 733-0344
Mailing address
106 W 105TH ST APT 16, NEW YORK, NY 10025-8802
(917) 733-0344
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
207239-1
NY
Other
Enumeration date
08/30/2018
Last updated
01/04/2024
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