Provider Demographics
NPI:1063666865
Name:BUONOCORE, JENNIFER MURRAY (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MURRAY
Last Name:BUONOCORE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 MARA CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1635
Mailing Address - Country:US
Mailing Address - Phone:516-431-1688
Mailing Address - Fax:
Practice Address - Street 1:310 NATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3326
Practice Address - Country:US
Practice Address - Phone:516-431-2929
Practice Address - Fax:516-431-6278
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011735-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor