Healthcare Provider Details

I. General information

NPI: 1740486885
Provider Name (Legal Business Name): JACLYN H. BONDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN LESLIE HALPERN M.D.

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST BAKER PAVILION 16TH FLOOR
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST BAKER PAVILION 16TH FLOOR
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-1500
  • Fax: 212-746-8303
Mailing address:
  • Phone: 212-746-1500
  • Fax: 212-746-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number247339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: