MEDICARE: DR. HANNIE ZOMER BOLANOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	V4526	TX
2	2080P0201X	Pediatric Allergy/Immunology Physician	317819	NY

General Provider Information

NPI Number	:	1700319126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANNIE ZOMER BOLANOS MD

Provider Business Mailing Address
First Line	:	1525 BLONDELL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2649
Country	:	US
Telephone Number	:	718-405-8530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 MORRIS PARK AVE STE 3
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1925
Country	:	US
Telephone Number	:	347-498-2410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	06/09/2026

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