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General NPI Number Information
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NPI Number | 1659592970
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Entity Type | Individual
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Provider Name | PHILIP ANTHONY BONGIORNO OTR
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 187 VETERANS BLVD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4982
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Country | US
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Telephone | 516-826-4303
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Fax | 516-826-9793
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Provider Business Mailing Address
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Address Line | 143 COUNTRY CLUB DRIVE
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City | COMMACK
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State | NY
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Zip | 11725
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Country | US
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Telephone | 631-804-1423
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0008341
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License Number State | NY
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