Provider Demographics
NPI:1255566113
Name:ANDREA BUONATO D.C., P.C.
Entity type:Organization
Organization Name:ANDREA BUONATO D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-494-2375
Mailing Address - Street 1:23 ANDES PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5524
Mailing Address - Country:US
Mailing Address - Phone:718-494-2375
Mailing Address - Fax:718-477-9987
Practice Address - Street 1:23 ANDES PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5524
Practice Address - Country:US
Practice Address - Phone:718-494-2375
Practice Address - Fax:718-477-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX3Y501Medicare PIN
NYU84661Medicare UPIN