Provider Demographics
NPI:1750460960
Name:BONANNO, JOSEPH (DO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:BONANNO
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 1:3481 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2016
Mailing Address - Country:US
Mailing Address - Phone:718-319-8800
Mailing Address - Fax:718-319-8808
Practice Address - Street 1:3481 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2016
Practice Address - Country:US
Practice Address - Phone:718-319-8800
Practice Address - Fax:718-319-8808
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187793207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY187793OtherLICENSE NUMBER
P714659OtherOXFORD NUMBER
P714659OtherOXFORD NUMBER
P714659OtherOXFORD NUMBER
NY187793OtherLICENSE NUMBER