Provider Demographics
NPI:1356681282
Name:BONGIORNO, SUSAN M (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 QUAY CT
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1659
Mailing Address - Country:US
Mailing Address - Phone:516-361-4544
Mailing Address - Fax:631-261-2739
Practice Address - Street 1:3 QUAY CT
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1659
Practice Address - Country:US
Practice Address - Phone:516-361-4544
Practice Address - Fax:631-261-2739
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306285-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse