Healthcare Provider Details

I. General information

NPI: 1124125810
Provider Name (Legal Business Name): BONNIE A MULLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 STATE ROUTE 208 STE 13
MONROE NY
10950-4649
US

IV. Provider business mailing address

2 COATES DR
GOSHEN NY
10924-6758
US

V. Phone/Fax

Practice location:
  • Phone: 845-783-0911
  • Fax: 845-783-9570
Mailing address:
  • Phone: 845-651-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: