Provider Demographics
NPI:1447260674
Name:BONFIGLIO REHABILITATION SERVICES, PC
Entity type:Organization
Organization Name:BONFIGLIO REHABILITATION SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BONFIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-780-0741
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-0248
Mailing Address - Country:US
Mailing Address - Phone:412-977-0980
Mailing Address - Fax:
Practice Address - Street 1:5620 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15632-9035
Practice Address - Country:US
Practice Address - Phone:412-780-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091328208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019122100001Medicaid
MIH49856Medicare UPIN
MI0P53000Medicare PIN