MEDICARE: ANNEMARIE BONAWITZ-DODI 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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	258734	NY

General Provider Information

NPI Number	:	1952610701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNEMARIE BONAWITZ-DODI M.D.

Provider Business Mailing Address
First Line	:	121 PIERMONT AVE
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-4513
Country	:	US
Telephone Number	:	248-390-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	942 ROUTE 376 STE 201
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-6493
Country	:	US
Telephone Number	:	845-765-2366
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	07/21/2020

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