Individual
VINCENT R BONAGURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
865 NORTHERN BLVD, SUITE 101, GREAT NECK, NY 11021-5310
(516) 622-5070
(516) 622-5060
Mailing address
175 COMMUNITY DR, 2ND FLOOR, GREAT NECK, NY 11021-5502
(516) 465-1900
(516) 465-1830
Taxonomy
Speciality
Code
Description
License number
State
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
127269
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00828937
—
NY
Enumeration date
10/03/2006
Last updated
07/08/2007
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