MEDICARE: ROBERT BONES

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	1041C0700X	Clinical Social Worker	R071845-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R071845-1	OTHER	NY	SOCIAL WORK

General Provider Information

NPI Number	:	1538307632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BONES

Provider Business Mailing Address
First Line	:	100 ALCOTT PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-4102
Country	:	US
Telephone Number	:	718-862-0987
Fax Number	:	718-466-6098

Provider Business Practice Location Address
First Line	:	1265 FRANKLIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3501
Country	:	US
Telephone Number	:	718-862-0987
Fax Number	:	718-466-6098

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

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	01/27/2009

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