Healthcare Provider Details

I. General information

NPI: 1407963200
Provider Name (Legal Business Name): WALTHER H.O. BOHNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1104
  • Fax: 212-717-1016
Mailing address:
  • Phone: 212-606-1104
  • Fax: 212-717-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number103032-A
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: