Healthcare Provider Details

I. General information

NPI: 1871546192
Provider Name (Legal Business Name): LAWRENCE MICHAEL BUONO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41705 COUNTY ROAD 48
SOUTHOLD NY
11971-5016
US

IV. Provider business mailing address

260 E MIDDLE COUNTRY RD SUITE 201
SMITHTOWN NY
11787-2982
US

V. Phone/Fax

Practice location:
  • Phone: 631-265-8780
  • Fax: 631-265-8521
Mailing address:
  • Phone: 631-265-8780
  • Fax: 631-265-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number213972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: