MEDICARE: MS. VALERIE BONO PA

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	363A00000X	Physician Assistant	007416	NY

General Provider Information

NPI Number	:	1568632909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE BONO PA

Provider Business Mailing Address
First Line	:	506 6TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3609
Country	:	US
Telephone Number	:	718-780-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 BAY 20TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4622
Country	:	US
Telephone Number	:	718-837-9238
Fax Number	:

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

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	06/03/2008

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