Provider Demographics
NPI:1528476041
Name:BONDARSKY, OLIVIA
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:BONDARSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WESTGATE RD APT A
Mailing Address - Street 2:A
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5044
Mailing Address - Country:US
Mailing Address - Phone:347-433-4276
Mailing Address - Fax:
Practice Address - Street 1:17 WESTGATE RD APT A
Practice Address - Street 2:A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5044
Practice Address - Country:US
Practice Address - Phone:347-433-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3562151171M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator