Individual
MR. HENRI ALEXANDER BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1312 MIDDLE COUNTRY RD, SELDEN, NY 11784-2514
(631) 732-0700
Mailing address
254 MADISON AVE, BRENTWOOD, NY 11717-2245
(631) 355-3817
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
014918-01
NY
Other
Enumeration date
02/16/2026
Last updated
02/16/2026
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