Healthcare Provider Details

I. General information

NPI: 1366355703
Provider Name (Legal Business Name): PETER ANTHONY BONADONNA EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RUTH ELLEN WAY
ROCHESTER NY
14624-3507
US

IV. Provider business mailing address

9 RUTH ELLEN WAY
ROCHESTER NY
14624-3507
US

V. Phone/Fax

Practice location:
  • Phone: 585-721-8656
  • Fax:
Mailing address:
  • Phone: 585-721-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number052552
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: