Individual
MICHAEL THOMAS BONACUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
15 SHADOW LN, EAST WILLISTON, NY 11596-2510
(516) 384-4354
Mailing address
15 SHADOW LN, EAST WILLISTON, NY 11596-2510
(516) 384-4354
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/27/2018
Last updated
04/27/2018
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