Individual
DR. GREGORY STEPHEN BONISTALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AU.D.
Contact information
Practice address
3181 LONG BEACH RD, OCEANSIDE, NY 11572-4107
(516) 208-2000
(516) 208-2004
Mailing address
3181 LONG BEACH RD, OCEANSIDE, NY 11572-4107
(516) 208-2000
(516) 208-2004
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
002865
NY
237600000X
Audiologist-Hearing Aid Fitter
14000057896
NY
237600000X
Audiologist-Hearing Aid Fitter
15000057896
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05808177
—
NY
Enumeration date
07/17/2019
Last updated
02/09/2022
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