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General NPI Number Information
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NPI Number | 1669580759
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Entity Type | Individual
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Provider Name | JONATHAN DANIEL BONIUK MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 3220 ARLINGTON AVE 7
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City | BRONX
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State | NY
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Zip | 10463-3354
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Country | US
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Telephone | 718-432-2299
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Fax | 718-432-2069
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Provider Business Mailing Address
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Address Line | 2717 ARLINGTON AVE
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City | BRONX
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State | NY
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Zip | 10463-4806
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Country | US
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Telephone | 718-432-2299
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Fax | 718-432-2069
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 199677
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License Number State | NY
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