Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | ||
Y | 2251P0200X | Physical Therapist - Pediatrics | 020169 | NY |
NPI | 1083855613 |
---|---|
Provider Name | Mrs. Donna Angela Bonomi |
First Address | Staten Island, NY 10309-1735 |
Second Address | Staten Island, NY 10309-1735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2009 |
Last Update Date | 19/03/2012 |