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
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