Individual
DEXTER BONGATO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6805 FRESH POND RD, RIDGEWOOD, NY 11385-5200
(718) 456-2545
(718) 559-6784
Mailing address
6805 FRESH POND RD, RIDGEWOOD, NY 11385-5200
(718) 456-2545
(718) 559-6784
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
036357
NY
Other
Enumeration date
10/22/2015
Last updated
10/22/2015
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