MEDICARE: DR. ROBERT WALTER BOHNENBERGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP3000X	Pediatric Anesthesiology Physician	169720	NY
2	207L00000X	Anesthesiology Physician	169720	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043280456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WALTER BOHNENBERGER MD

Provider Business Mailing Address
First Line	:	15 WESTBURY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2025
Country	:	US
Telephone Number	:	718-447-8665
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 BARD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1664
Country	:	US
Telephone Number	:	718-818-3298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/13/2022

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