Individual
DR. GREGORY N. BONASERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1041 ROUTE 112, PORT JEFFERSON STATION, NY 11776-6000
(631) 828-4545
(631) 642-1070
Mailing address
1041 ROUTE 112, PORT JEFFERSON STATION, NY 11776-6000
(631) 445-1011
(631) 642-1070
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X005301
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01738361
—
NY
Enumeration date
10/24/2006
Last updated
11/14/2018
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