Provider Demographics
NPI:1346693207
Name:BONO SURGICAL SPECIALTIES LLC
Entity Type:Organization
Organization Name:BONO SURGICAL SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-572-3100
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:WHITE HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:18661-0158
Mailing Address - Country:US
Mailing Address - Phone:267-572-3100
Mailing Address - Fax:267-572-3161
Practice Address - Street 1:280 MIDDLETOWN BLVD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1816
Practice Address - Country:US
Practice Address - Phone:267-572-3100
Practice Address - Fax:267-572-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065162L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty