MEDICARE: JAIME BONURA

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
1	163WS0200X	School Registered Nurse	552429	NY

General Provider Information

NPI Number	:	1275377186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME BONURA

Provider Business Mailing Address
First Line	:	6019 AMBOY RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 JEFFERSON BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3329
Country	:	US
Telephone Number	:	347-996-2519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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Directions to “ JAIME BONURA ” Practice Location

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