Healthcare Provider Details

I. General information

NPI: 1316094428
Provider Name (Legal Business Name): STEVEN BONVINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SEGUINE AVE
STATEN ISLAND NY
10309
US

IV. Provider business mailing address

ONE EDGEWATER STREET SUITE 723
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9488
  • Fax: 718-226-8132
Mailing address:
  • Phone: 718-226-4324
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number213748
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number213748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: