Provider Demographics
NPI:1609816909
Name:BUONO, LUIGI (DO)
Entity Type:Individual
Prefix:
First Name:LUIGI
Middle Name:
Last Name:BUONO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2121
Mailing Address - Country:US
Mailing Address - Phone:631-298-4479
Mailing Address - Fax:631-591-3047
Practice Address - Street 1:7905 MAIN RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-1518
Practice Address - Country:US
Practice Address - Phone:631-298-2030
Practice Address - Fax:631-298-8915
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191456-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1480533Medicaid
NY1480533Medicaid
NY67I881Medicare ID - Type Unspecified