Provider Demographics
NPI:1639557416
Name:JOSEPH N. BONAVOGLIA, DC
Entity Type:Organization
Organization Name:JOSEPH N. BONAVOGLIA, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HALKIAS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:347-843-8657
Mailing Address - Street 1:161 MCDONNELL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-5316
Mailing Address - Country:US
Mailing Address - Phone:347-843-8657
Mailing Address - Fax:347-802-4241
Practice Address - Street 1:139 E 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2102
Practice Address - Country:US
Practice Address - Phone:347-843-8657
Practice Address - Fax:347-802-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty