Individual
DR. LISA MARIE BONVINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
101 HOSPITAL RD, PATCHOGUE, NY 11772-4870
(631) 447-3048
Mailing address
21 INGELORE CT, SMITHTOWN, NY 11787-1705
(631) 724-4859
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
223033
NY
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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