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General NPI Number Information
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NPI Number | 1528232394
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Entity Type | Individual
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Provider Name | ALEXIS BONEPARTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 3959 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1559
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Country | US
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Telephone | 212-305-9304
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Fax |
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Provider Business Mailing Address
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Address Line | 3959 BROADWAY # 7C
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City | NEW YORK
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State | NY
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Zip | 10032-1559
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 247973
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number | 25MA09256300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number | 247973
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License Number State | NY
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