Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 197766 | NY |
NPI | 1053316505 |
---|---|
Provider Name | Eugene S Bonapace JR. |
First Address | New Hyde Park, NY 11042-2058 |
Second Address | New Hyde Park, NY 11042-2058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 26/02/2021 |