MEDICARE: EDUARDO CANLAS BONDOC M.D.

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	2084P0800X	Psychiatry Physician	181702	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06851	OTHER	NY	GHI MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1699771477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO CANLAS BONDOC M.D.

Provider Business Mailing Address
First Line	:	119 HINSDALE AVE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-1213
Country	:	US
Telephone Number	:	516-358-2388
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 COURTLANDT AVE
Second Line	:	FL 2
City	:	BRONX
State	:	NY
Zip	:	10451-5008
Country	:	US
Telephone Number	:	718-312-6480
Fax Number	:	718-292-4641

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

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	03/24/2018

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