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General NPI Number Information
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NPI Number | 1902759335
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Entity Type | Individual
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Provider Name | HENRI ALEXANDER BONILLA PTA
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Gender | Male
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1312 MIDDLE COUNTRY RD
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City | SELDEN
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State | NY
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Zip | 11784-2514
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Country | US
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Telephone | 631-732-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 254 MADISON AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-2245
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Country | US
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Telephone | 631-355-3817
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 014918-01
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License Number State | NY
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