Healthcare Provider Details

I. General information

NPI: 1467560276
Provider Name (Legal Business Name): JULIA BONDARENKO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BRIGHTON BEACH AVE APT 1CC
BROOKLYN NY
11235-5515
US

IV. Provider business mailing address

117 CHESTER AVE
STATEN ISLAND NY
10312-5710
US

V. Phone/Fax

Practice location:
  • Phone: 718-648-2707
  • Fax: 347-462-2908
Mailing address:
  • Phone: 917-699-4139
  • Fax: 718-966-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006041-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: