Provider Demographics
NPI:1073876413
Name:CAVUOTO/KADER, BONNIE SUE
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUE
Last Name:CAVUOTO/KADER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:SUE
Other - Last Name:ITZKOWITZ/
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:19 MONTAUK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4594
Mailing Address - Country:US
Mailing Address - Phone:516-642-8533
Mailing Address - Fax:516-442-0882
Practice Address - Street 1:19 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4594
Practice Address - Country:US
Practice Address - Phone:516-642-8533
Practice Address - Fax:516-442-0882
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist