Organization
CHIROPRACTIC OF STONY BROOK PLLC
Active
Organization
CHIROPRACTIC OF STONY BROOK PLLC
Active
Other names
PORT JEFF STATION CHIROPRACTIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY N. BONASERA D.C. (MEMBER)
(631) 828-4545
Entity
Organization
Contact information
Practice address
1041 ROUT 112, PORT JEFFERSON STATION, NY 11776
(631) 828-4545
(631) 642-1070
Mailing address
1041 ROUTE 112, PORT JEFFERSON STATION, NY 11776-6000
(631) 828-4545
(631) 642-1070
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
261Q00000X
Clinic/Center
Primary
X005301-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01738361
—
NY
Enumeration date
02/14/2007
Last updated
01/22/2019
Update your record
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