Individual
PHILIP BONANNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
70 GLEN ST STE 380, GLEN COVE, NY 11542-2858
(516) 671-5676
Mailing address
70 GLEN ST STE 380, GLEN COVE, NY 11542-2858
(516) 671-5676
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
124617
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00391873
—
NY
Enumeration date
11/04/2005
Last updated
07/31/2014
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