Provider Demographics
NPI:1891968236
Name:DR JOSEPH BONANNO PHYSICIAN PC
Entity Type:Organization
Organization Name:DR JOSEPH BONANNO PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-863-7925
Mailing Address - Street 1:2217 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5826
Mailing Address - Country:US
Mailing Address - Phone:718-863-7925
Mailing Address - Fax:718-863-8208
Practice Address - Street 1:3101 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5705
Practice Address - Country:US
Practice Address - Phone:718-863-7925
Practice Address - Fax:718-863-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187793207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY187793OtherLICENSE
NY187793OtherLICENSE