MEDICARE: JANICE BONSU

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	171W00000X	Contractor	72-091184	NY

General Provider Information

NPI Number	:	1902212376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE BONSU

Provider Business Mailing Address
First Line	:	800 CONCOURSE VLG W
Second Line	:	16D
City	:	BRONX
State	:	NY
Zip	:	10451-3607
Country	:	US
Telephone Number	:	347-886-4855
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 CONCOURSE VLG W
Second Line	:	16D
City	:	BRONX
State	:	NY
Zip	:	10451-3607
Country	:	US
Telephone Number	:	347-886-4855
Fax Number	:

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	07/07/2014

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