Provider Demographics
NPI:1871754143
Name:BONAMO, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BONAMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:WACCABUC
Mailing Address - State:NY
Mailing Address - Zip Code:10597-0397
Mailing Address - Country:US
Mailing Address - Phone:917-864-2116
Mailing Address - Fax:914-833-1376
Practice Address - Street 1:15 KINGSBURY RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-4718
Practice Address - Country:US
Practice Address - Phone:917-864-2116
Practice Address - Fax:914-833-1376
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103909207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine