Provider Demographics
NPI:1871602540
Name:JOHN BUONOCORE DO PC
Entity type:Organization
Organization Name:JOHN BUONOCORE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BUONOCORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-422-0852
Mailing Address - Street 1:946 LITTLE EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4620
Mailing Address - Country:US
Mailing Address - Phone:631-422-0852
Mailing Address - Fax:
Practice Address - Street 1:946 LITTLE EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-4620
Practice Address - Country:US
Practice Address - Phone:631-422-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182693207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty