Provider Demographics
NPI:1669580759
Name:BONIUK, JONATHAN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DANIEL
Last Name:BONIUK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2717 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4806
Mailing Address - Country:US
Mailing Address - Phone:718-432-2299
Mailing Address - Fax:718-432-2069
Practice Address - Street 1:3220 ARLINGTON AVE 7
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3354
Practice Address - Country:US
Practice Address - Phone:718-432-2299
Practice Address - Fax:718-432-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY199677207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01592070Medicaid
NY70T561Medicare ID - Type Unspecified
NY01592070Medicaid