Healthcare Provider Details

I. General information

NPI: 1003457698
Provider Name (Legal Business Name): ANTHONY F BONGIOVANNI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ALBERTA DR STE 211
AMHERST NY
14226-1814
US

IV. Provider business mailing address

315 ALBERTA DR STE 211
AMHERST NY
14226-1814
US

V. Phone/Fax

Practice location:
  • Phone: 716-837-6705
  • Fax: 716-837-6759
Mailing address:
  • Phone: 716-837-6705
  • Fax: 716-837-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY F BONGIOVANNI
Title or Position: OWNER SINGLE MEMBER LLC
Credential: PH.D.
Phone: 716-969-3756