Provider Demographics
NPI:1578510947
Name:FORMAN-FRANCO, BONNIE SUE (AUD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:SUE
Last Name:FORMAN-FRANCO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W PARK AVE
Mailing Address - Street 2:SUITE 3J
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3301
Mailing Address - Country:US
Mailing Address - Phone:516-432-1800
Mailing Address - Fax:516-432-0421
Practice Address - Street 1:120 W PARK AVE
Practice Address - Street 2:SUITE 3J
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3301
Practice Address - Country:US
Practice Address - Phone:516-432-1800
Practice Address - Fax:516-432-0421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000052-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM03661Medicare UPIN
NYM0W011Medicare ID - Type Unspecified