Jorge Bonilla MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

JORGE BONILLA MD PC

Practice address

191 W Hoffman Ave
Lindenhurst, NY 11757-4036

Phone

(631) 608-4741

Fax

(631) 608-4742

NPI assigned

May 17, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jorge Bonilla, MDNPI 1376834176

Title

MD

Phone

(631) 608-4741

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jorge Bonilla, M.D

  • Internal Medicine Physician
  • Lindenhurst, NY
  • NPI 1376834176
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1669038329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 BROADWAY STE 1",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012797",
            "telephone_number": "631-608-4741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 W HOFFMAN AVE",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117574036",
            "telephone_number": "631-608-4741",
            "fax_number": "631-608-4742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORGE BONILLA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-17",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "BONILLA",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "631-608-4741",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "264692",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Jennings, M.S., CF-SLP
• Changlong Jiang, MS
• Hongmin Jin
• Kristy Ann Johnston, SLP
• Jolore Services Corporation
• Paul Scott Kahl, D.D.S.
• Lisa M. Kalimi, MD
• Elliot David Kalker, M.D.
• Ayse Kanca
• Joanne Kane, P.T.

• Internal Medicine Physician in Lindenhurst, NY
• Providers in Lindenhurst, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.