Provider Demographics
NPI:1699771477
Name:BONDOC, EDUARDO CANLAS (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:CANLAS
Last Name:BONDOC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HINSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1213
Mailing Address - Country:US
Mailing Address - Phone:516-358-2388
Mailing Address - Fax:
Practice Address - Street 1:522 COURTLANDT AVE
Practice Address - Street 2:FL 2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5008
Practice Address - Country:US
Practice Address - Phone:718-312-6480
Practice Address - Fax:718-292-4641
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1817022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06851OtherGHI MEDICARE
NY01420795Medicaid
NY01301537Medicaid
NY03656HMedicare PIN
NYE48913Medicare UPIN
NY01420795Medicaid