Individual
DR. BONEH G AVIDOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
10 CIRCLE DR, SHOREHAM, NY 11786-1321
(631) 744-3458
Mailing address
10 CIRCLE DR, SHOREHAM, NY 11786-1321
(631) 744-3458
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
013307-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01808424
—
NY
Enumeration date
10/03/2006
Last updated
07/08/2007
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