Healthcare Provider Details

I. General information

NPI: 1144256504
Provider Name (Legal Business Name): LUKE BONGIORNIO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 57TH ST STE 1406
NEW YORK NY
10019-2802
US

IV. Provider business mailing address

3636 33RD ST
ASTORIA NY
11106-2329
US

V. Phone/Fax

Practice location:
  • Phone: 212-399-3800
  • Fax: 212-399-3822
Mailing address:
  • Phone: 718-707-6970
  • Fax: 718-707-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018838-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: