JUAN SAMUEL BONILLA-PEREZ (NPI# 1205039757) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205039757 |
| Entity Type | Individual |
| Full Name | JUAN SAMUEL BONILLA-PEREZ |
| Credential | M.D. |
| Practice Address |
1065 Southern Blvd Bronx NY 10459 |
| Mailing Address |
1065 Southern Blvd Bronx NY 10459-2417 |
| Practice Telephone | 7185892440 |
| Mailing Telephone | 7185892440 |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2019-05-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 16664 | PR | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD041056 | DC | Allopathic & Osteopathic Physicians |
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
292251-1 | NY | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1065 Southern Blvd, Bronx, NY 10459 | 7185892440 | 9174633208 |
| Street Address |
1065 SOUTHERN BLVD |
| City | BRONX |
| State | NY |
| Zip Code | 10459 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609872035 | Claude Parola | Internal Medicine | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2005-06-21 |
| 1386243582 | Maribel Luna Cruz | Radiologic Technologist | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2020-10-20 |
| 1669080685 | Anna Katrina Reyes Florendo | Nurse Practitioner | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2020-07-15 |
| 1588280911 | Daniel James Mulcahy | Physician Assistant | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2020-06-22 |
| 1629691142 | Kelly K Smith | Nurse Practitioner | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2020-05-19 |
| 1740813856 | Oresta Victoria Borodevyc | Physician Assistant | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2020-02-17 |
| 1891327557 | Temina A Kusi | Physician Assistant | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2020-02-10 |
| 1780220590 | Maria Feliz | Social Worker | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2019-11-27 |
| 1104460237 | Josiah Guitian | Physician Assistant | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2019-11-01 |
| 1508400938 | Nayary Santana | Social Worker | 1065 Southern Blvd, Bronx, NY 10459-2417 | 2019-10-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912508458 | Sterling Smiles LLC | Dentist | 1022 E163rd St, Bronx, NY 10459 | 2020-11-02 |
| 1710496633 | Vitus C. Ezerioha | Licensed Practical Nurse | 870 Southern Blvd., Apt 1a, Bronx, NY 10459 | 2017-09-22 |
| 1790208403 | Jessica S Lee | Early Intervention Provider Agency | 985 Intervale Ave Apt. 2c, Bronx, NY 10459 | 2017-07-25 |
| 1669901070 | Ruthlyn Merrick | Registered Nurse | 1466 Louis Nine Blvd, Bronx, NY 10459 | 2017-06-08 |
| 1154865681 | John Wahl | Speech-Language Pathologist | 977 Fox St., Is 217, Bronx, NY 10459 | 2016-12-19 |
| 1801349675 | Aneesa Ible | Social Worker | 953 Southern Blvd, Suite 301, Odyssey House Inc., Bronx, NY 10459 | 2016-07-28 |
| 1457711277 | Agboade Ademiju | Registered Nurse | 900 Intervale Ave, Archcare, Bronx, Bronx, NY 10459 | 2016-03-07 |
| 1952760076 | Apollo Radio Dispatcher | Taxi | 801 Freeman Street, Bronx, NY 10459 | 2016-02-17 |
| 1730547522 | Foxhurst Medical of New York LLC | Surgery | 947 Southern Blvd Ste B, Bronx, NY 10459 | 2016-02-08 |
| 1063892388 | Vismar Radio Dispatch Inc. | Taxi | 1040-52 Freeman St, Bronx, NY 10459 | 2015-06-02 |
| Find all providers in zip 10459 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316316789 | Balance Medical Professional Primary Services Pllc | Family Medicine | 1150 Webster Ave., Bronx, NY 10456 | 2015-09-16 |
| 1467857508 | Arghavan Sadeghizangeneh | Family Medicine | 1276 Fulton Ave Fl 4, Bronx, NY 10456-3402 | 2014-10-31 |
| 1679976682 | Idelka Grisselle Rodriguez | Family Medicine | 2300 Westchester Ave, Bronx, NY 10462-5072 | 2014-10-03 |
| 1619983251 | Elisa Jacqueline Valencia-sanchez | Family Medicine | 130 W Kingsbridge Rd, Bronx, NY 10468-3904 | 2006-08-01 |
| 1528081320 | Brian Delaney | Family Medicine | 2371 Arthur Ave, Bronx, NY 10458-8113 | 2006-07-25 |
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|---|---|---|---|---|
| 1245682475 | Salut Medical PC | Family Medicine | 699 Stanley Ave, Brooklyn, NY 11207-7905 | 2016-07-12 |
| 1225416837 | Good Neighbor Family Practice and Geriatrics, P.C. | Family Medicine | 13338 41st Rd Ste Co-3, Flushing, NY 11355-3782 | 2015-05-14 |
| 1245667930 | Yelena Faynzilbert Do Pllc | Family Medicine | 62 Stratford Green, Farmingdale, NY 11735 | 2013-09-26 |
| 1063779346 | Melissa Borrero Md, Pllc | Family Medicine | 405 E 116th St, Unit 2, New York, NY 10029-1623 | 2012-04-11 |
| 1588943047 | J&j Star Medical Pllc | Family Medicine | 9320 70th Ave, Forest Hills, NY 11375-5828 | 2011-08-15 |
| 1629360995 | Eugene A Steinberg Md PC | Family Medicine | 8 Thames Ct, Getzville, NY 14068-1177 | 2011-05-05 |
| 1891010781 | Christine R. Viola | Family Medicine | 415 Ocean Pkwy, 4a, Brooklyn, NY 11218-4748 | 2010-04-02 |
| 1518190305 | Raouf Kodsy Physician PC | Family Medicine | 1644 Genesee St, Utica, NY 13502-5428 | 2009-08-27 |
| 1467694703 | Amandeep Pal | Family Medicine | 6334 Robinson Rd, Lockport, NY 14094 | 2009-04-01 |
| 1154586295 | Wilhelm Gustav Hansen | Family Medicine | 1013 Hector St, Ithaca, NY 14850-2037 | 2008-07-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.