Individual provider Active NPI

Edward Joseph Bonfiglio Jr., PA-C

  • Physician Assistant
  • Albany, NY
National Provider Identifier
1891344735
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010992 Issued in MI
Practice address
5 Palisades Dr Ste 100
Albany, NY 12205-6433
Phone
(518) 438-4496
Fax
(518) 438-5803
NPI assigned
Sep 4, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601010992 MI Primary

Addresses

Primary practice location

5 Palisades Dr Ste 100
Albany, NY 12205-6433

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (185) 255-6345

Other practice location 1

2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone (734) 246-6000

Other practice location 2

2 New Hampshire Ave
Troy, NY 12180-1764
Phone (518) 272-0331

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201014000815 NY Practitioner - Physician Assistant 0446670400 Reassigns benefits to 1 organization
I20220518001623 MI Practitioner - Physician Assistant 0446670400 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Peter'S Health Partners Medical Associates, P.C.Group PAC ID 6103061189, 480 clinicians

Practice addresses (Care Compare)

2 New Hampshire Ave
Troy, NY 12180-1764
Phone (518) 525-8220

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-1852

Hospital & facility affiliations

  • St Peter'S Hospital Hospital, Albany, NY, CCN 330057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
024667NYMDMassage Therapist
5601010992MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation CurrentSince Jan 1, 2025 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince May 17, 2022 Accepting new patients
Henry Ford Health System CurrentSince May 17, 2022 Accepting new patients
W.a. Foote Memorial Hospital, Inc Physician Assistant CurrentSince Jan 1, 2025 Accepting new patients
Henry Ford Health System Physician Assistant CurrentSince May 17, 2022 Accepting new patients
Henry Ford Wyandotte Hospital Physician Assistant CurrentSince May 17, 2022 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Jan 1, 2025 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Jan 1, 2025 Accepting new patients
St. Peter'S Health Partners Medical Associates, P.C. Physician Assistant CurrentSince Aug 4, 2025 Accepting new patients
St. Peter'S Health Partners Medical Associates, P.C. Physician Assistant Past Accepting new patients
Henry Ford Wyandotte Hospital Past Accepting new patients
Wa Foote Memorial Hospital, Inc Physician Assistant Past Accepting new patients

Locations

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

7845 Spring Arbor Rd
Spring Arbor, MI 49283
Phone (517) 205-2580

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

5 Palisades Dr
Ste 100
Albany, NY 12205
Phone (518) 438-4496

2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331

Interoperability endpoints

  • Direct secure messaging: ebonfiglio4491363@direct.trinity-health.org
  • Direct secure messaging: ebonfiglio782198@direct.hfhs.org

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 16

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1891344735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "185-255-6345",
            "fax_number": "518-649-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PALISADES DR STE 100",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122056433",
            "telephone_number": "518-438-4496",
            "fax_number": "518-438-5803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2333 Biddle Ave",
            "address_purpose": "LOCATION",
            "city": "Wyandotte",
            "state": "MI",
            "postal_code": "481924668",
            "country_code": "US",
            "telephone_number": "734-246-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 New Hampshire Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121801764",
            "country_code": "US",
            "telephone_number": "518-272-0331",
            "fax_number": "518-271-9007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONFIGLIO",
        "first_name": "EDWARD",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-04",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP-Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "5 Palisades Dr Ste 100",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122056433",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP-Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2 New Hampshire Ave",
            "city": "Troy",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121801764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.