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General NPI Number Information
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NPI Number | 1750782900
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Entity Type | Individual
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Provider Name | MICHAEL BONOMO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 24302 NORTHERN BLVD
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City | DOUGLASTON
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State | NY
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Zip | 11362-1150
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Country | US
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Telephone | 718-423-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 22 BOB-O-LINK LANE
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City | NORTHPORT
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State | NY
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Zip | 11768-3305
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Country | US
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Telephone | 917-837-5922
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021438
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License Number State | NY
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