Provider Demographics
NPI:1427207380
Name:BONASERA, ANATY
Entity Type:Individual
Prefix:MRS
First Name:ANATY
Middle Name:
Last Name:BONASERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4815
Mailing Address - Country:US
Mailing Address - Phone:631-979-7056
Mailing Address - Fax:
Practice Address - Street 1:48 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4815
Practice Address - Country:US
Practice Address - Phone:631-979-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker