Provider Demographics
NPI:1619938495
Name:BUONASPINA, ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:BUONASPINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EDGEGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3332
Mailing Address - Country:US
Mailing Address - Phone:718-984-5437
Mailing Address - Fax:718-984-5488
Practice Address - Street 1:107 EDGEGROVE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3332
Practice Address - Country:US
Practice Address - Phone:718-984-5437
Practice Address - Fax:718-984-5488
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181489208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01429092Medicaid
NY01429092Medicaid