Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 270 | CT |
NPI | 1033239397 |
---|---|
Provider Name | Dr. Vincent M Buonanno |
First Address | Greenwich, CT 06831-5351 |
Second Address | Greenwich, CT 06831-5351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 22/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
222346845 | TAX ID (01) | CT |