Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 36476 | MN |
N | 207PP0204X | Pediatric Emergency Physician | 36476 | MN |
N | 208000000X | Pediatrician | 36476 | MN |
Y | 2080P0204X | Pediatric Emergency Doctor | 36476 | MN |
NPI | 1134206188 |
---|---|
Provider Name | William A Bonadio |
First Address | New York, NY 10025-1716 |
Second Address | New York, NY 10025-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
535762400 | (05) | MN |
B51643 | (02) |