Provider Demographics
NPI:1144461146
Name:T. BONNETT MEDICAL SERVICES P.C
Entity type:Organization
Organization Name:T. BONNETT MEDICAL SERVICES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKETT-BONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-404-6508
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-0069
Mailing Address - Country:US
Mailing Address - Phone:347-404-6508
Mailing Address - Fax:718-484-2415
Practice Address - Street 1:423 LINCOLN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5497
Practice Address - Country:US
Practice Address - Phone:347-404-6508
Practice Address - Fax:718-484-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01988696Medicaid
H24680Medicare UPIN
NY01988696Medicaid