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Contact Information

VINCENT R BONAGURA, MD
865 NORTHERN BLVD
SUITE 101
GREAT NECK, NY11021-5310
 Phone: 516-622-5070
 Fax: 516-622-5060
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Allergy/Immunology

2080P0201X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for VINCENT R BONAGURA · (Male)

NPI # 1568556629
Status Active
Credentials MD
Entity Individual
Enumeration date 10/03/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 127269
  • NY Medicaid 00828937
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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