Individual
LOUIS BONAVITA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4939 BRITTONFIELD PKWY, SUITE 101, EAST SYRACUSE, NY 13057-9208
(315) 463-1600
(315) 634-6793
Mailing address
4939 BRITTONFIELD PKWY, SUITE 101, EAST SYRACUSE, NY 13057-9208
(315) 463-1600
(315) 634-6793
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1840951
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01937553
—
NY
Enumeration date
10/05/2005
Last updated
10/22/2013
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