Provider Demographics
NPI:1750554515
Name:BONANNO, LENORE (MS, PA)
Entity type:Individual
Prefix:MS
First Name:LENORE
Middle Name:
Last Name:BONANNO
Suffix:
Gender:F
Credentials:MS, PA
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Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL 100 NICOLLS RD
Mailing Address - Street 2:HSC T18-030
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8183
Mailing Address - Country:US
Mailing Address - Phone:631-444-3577
Mailing Address - Fax:631-444-8909
Practice Address - Street 1:STONY BROOK UNIVERSITY CANCER CTR
Practice Address - Street 2:3 EDMUND PELLEGRINO RD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8183
Practice Address - Country:US
Practice Address - Phone:631-444-3577
Practice Address - Fax:631-444-8909
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2017-08-28
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Provider Licenses
StateLicense IDTaxonomies
NYP63329363A00000X
NY013193363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant