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General NPI Number Information
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NPI Number | 1447687439
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Entity Type | Individual
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Provider Name | MAGGIE KATHLEEN BUONDELMONTE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 320 FRANKLIN AVE
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-1332
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Country | US
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Telephone | 516-328-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 3 LARK AVE
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City | OLD BETHPAGE
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State | NY
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Zip | 11804-1411
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Country | US
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Telephone | 631-793-0828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 016698
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License Number State | NY
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