Individual
DR. KEVIN BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3001 EXPRESS DR N, ISLANDIA, NY 11749-5301
(631) 292-6747
Mailing address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3322
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
315669-01
NY
Other
Enumeration date
04/10/2018
Last updated
06/09/2022
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