Healthcare Provider Details

I. General information

NPI: 1700319126
Provider Name (Legal Business Name): HANNIE ZOMER BOLANOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MORRIS PARK AVE STE 3
BRONX NY
10461-1925
US

IV. Provider business mailing address

1525 BLONDELL AVE
BRONX NY
10461-2649
US

V. Phone/Fax

Practice location:
  • Phone: 347-498-2410
  • Fax:
Mailing address:
  • Phone: 718-405-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number317819
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number317819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: