Healthcare Provider Details

I. General information

NPI: 1720202435
Provider Name (Legal Business Name): BONNIE KURTZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BONNIE KIMCHI

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST 4FL
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

130 E 77TH ST 4FL
NEW YORK NY
10075-1851
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-3222
  • Fax: 212-434-2837
Mailing address:
  • Phone: 212-434-3222
  • Fax: 212-434-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: