Provider Demographics
NPI:1952699506
Name:BUONVIAGGIO, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BUONVIAGGIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2351
Mailing Address - Country:US
Mailing Address - Phone:718-370-3500
Mailing Address - Fax:718-979-5236
Practice Address - Street 1:33 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5950
Practice Address - Country:US
Practice Address - Phone:718-982-6340
Practice Address - Fax:718-982-5358
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400059031Medicare PIN