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General NPI Number Information
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NPI Number | 1871754143
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Entity Type | Individual
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Provider Name | JOHN J BONAMO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 15 KINGSBURY RD
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City | NEW ROCHELLE
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State | NY
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Zip | 10804-4718
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Country | US
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Telephone | 917-864-2116
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Fax | 914-833-1376
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Provider Business Mailing Address
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Address Line | PO BOX 397
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City | WACCABUC
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State | NY
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Zip | 10597-0397
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Country | US
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Telephone | 917-864-2116
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Fax | 914-833-1376
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 103909
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License Number State | NY
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