Provider Demographics
NPI:1568609915
Name:BONGIORNO PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:BONGIORNO PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-750-1110
Mailing Address - Street 1:1841 BROADWAY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7603
Mailing Address - Country:US
Mailing Address - Phone:212-750-1110
Mailing Address - Fax:212-750-1170
Practice Address - Street 1:1841 BROADWAY
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-750-1110
Practice Address - Fax:212-750-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty