Provider Demographics
NPI:1184331894
Name:BONURA, VINCENT PAUL (DPT)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:PAUL
Last Name:BONURA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BAY SHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1711
Mailing Address - Country:US
Mailing Address - Phone:631-586-6616
Mailing Address - Fax:631-586-6617
Practice Address - Street 1:150 BAY SHORE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1711
Practice Address - Country:US
Practice Address - Phone:631-586-6616
Practice Address - Fax:631-586-6617
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist