Individual
DR. ANTHONY BONANNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
50 ROUTE 25A, SMITHTOWN, NY 11787
(631) 862-3413
(631) 862-3604
Mailing address
50 ROUTE 25A, EMPLOYEE SERVICES BUILDING, SMITHTOWN, NY 11787
(631) 862-3413
(631) 862-3604
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
167355
NY
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
167355-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01067216
—
NY
Enumeration date
09/29/2006
Last updated
01/28/2011
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