Basic Information
| Provider Information | |||||||||
| NPI: | 1235139775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONHEIM | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W MAIN ST | ||||||||
| Address2: | SUIRE 108 | ||||||||
| City: | BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117023027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315178006 | ||||||||
| FaxNumber: | 6315178007 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 ROUTE 111 | ||||||||
| Address2: | |||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117884370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312659645 | ||||||||
| FaxNumber: | 6312655589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 116260 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00948090 | 05 | NY | MEDICAID | RAILROAD MEDICARE | 01 | NY | P00127939 | OTHER |