Provider Demographics
NPI:1760447429
Name:BUONVINO, ANGELA (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BUONVINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 1ST ST
Mailing Address - Street 2:WINTHROP 2 ROOM 291
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3957
Mailing Address - Country:US
Mailing Address - Phone:515-663-8693
Mailing Address - Fax:516-663-8964
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:WINTHROP 2 ROOM 291
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:515-663-8693
Practice Address - Fax:516-663-8964
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196781208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP370396OtherOXFORD
NY01806151Medicaid
NY01806151Medicaid
NYP370396OtherOXFORD
NY749561Medicare ID - Type Unspecified