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NPI Code Detail

MEDICARE: VINCENT PAUL BONURA DPT

MEDICARE: VINCENT PAUL BONURA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist049387NY

General Provider Information

NPI Number : 1184331894
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT PAUL BONURA DPT
Provider Business Mailing Address
First Line : 150 BAY SHORE ROAD
Second Line :
City : NORTH BABYLON
State : NY
Zip : 11703-1711
Country : US
Telephone Number : 631-586-6616
Fax Number : 631-586-6617
Provider Business Practice Location Address
First Line : 150 BAY SHORE ROAD
Second Line :
City : NORTH BABYLON
State : NY
Zip : 11703-1711
Country : US
Telephone Number : 631-586-6616
Fax Number : 631-586-6617
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2022
Last Update Date : 11/02/2022

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Directions to “ VINCENT PAUL BONURA DPT” Practice Location

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