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General NPI Number Information
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NPI Number | 1700603719
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Entity Type | Individual
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Provider Name | MRS. DEBRA BONAMASSA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2024
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 14 RESEARCH WAY
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3453
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Country | US
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Telephone | 631-331-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 34 HENRY AVE
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City | BABYLON
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State | NY
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Zip | 11702-1303
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Country | US
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Telephone | 17-418-8639
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 139887
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License Number State | NY
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