Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 236458 | NY |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 236458 | NY |
NPI | 1164673349 |
---|---|
Provider Name | Clarissa Ann Bonanno |
First Address | New York, NY 10032-3720 |
Second Address | New York, NY 10032-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2008 |
Last Update Date | 30/07/2009 |