Provider Demographics
NPI:1669955829
Name:BONAMO, BRITTANY (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BONAMO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:GASKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:981 US HIGHWAY 22 FL 2
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2965 VETERANS RD W STE A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2516
Practice Address - Country:US
Practice Address - Phone:718-874-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043671225100000X
NJ40QA01813500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01813500Medicaid