Organization
PHILIP A. BONANNO, M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP A. BONANNO M.D., P.C. (OPHTHALMOLOGIST)
(516) 671-5676
Entity
Organization
Contact information
Practice address
70 GLEN ST, SUITE 380, GLEN COVE, NY 11542-2855
(516) 671-5676
(516) 671-6893
Mailing address
70 GLEN ST, SUITE 380, GLEN COVE, NY 11542-2855
(516) 671-5676
(516) 671-6893
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
08/31/2006
Last updated
07/31/2014
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