Richard Joseph Bonanno, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

118089 Issued in NY

Practice address

1869 Brentwood Rd
Brentwood, NY 11717-4625

Phone

(631) 853-3458

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Suffolk

  • Methadone Clinic
  • Smithtown, NY
  • NPI 1649374851
  NPD (past)
• County of Suffolk

  • Clinic/Center
  • Brentwood, NY
  • NPI 1851321152
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226966400000",
    "number": "1750472528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 PLYMOUTH AVE",
            "city": "BRIGHTWATERS",
            "state": "NY",
            "postal_code": "117181409",
            "telephone_number": "631-968-8517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1869 BRENTWOOD RD",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117174625",
            "telephone_number": "631-853-3458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONANNO",
        "first_name": "RICHARD",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2008-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "118089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00352727",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emmanuel Boadu
• Samuel Oteng Boadu
• Gina Bogdanowicz
• Janet Maria Boland
• Patrick Bonacum
• Ashaunti Bond, LPN
• Laurence Bonne Annee, LPN
• Syntia Bonne-Annee
• Amanda Alexis Boyer, LPN
• Michelle Bradford

• Family Medicine Physician in Brentwood, NY
• Providers in Brentwood, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.