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NPI Code Detail

MEDICARE: DR. GREGORY N. BONASERA DC

MEDICARE: DR. GREGORY N. BONASERA DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorX005301NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841374352
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY N. BONASERA DC
Provider Business Mailing Address
First Line : 1041 ROUTE 112
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-6000
Country : US
Telephone Number : 631-445-1011
Fax Number : 631-642-1070
Provider Business Practice Location Address
First Line : 1041 ROUTE 112
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-6000
Country : US
Telephone Number : 631-828-4545
Fax Number : 631-642-1070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 11/14/2018

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