Gregory N. Bonasera, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

X005301 Issued in NY

Practice address

1041 Route 112
Port Jefferson Station, NY 11776-6000

Phone

(631) 828-4545

Fax

(631) 642-1070

NPI assigned

Oct 24, 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

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Chiropractic of Stony Brook PLLC

  • Clinic/Center
  • Port Jefferson Station, NY
  • NPI 1891838538

  Chiropractor

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542153600000",
    "number": "1841374352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117766000",
            "telephone_number": "631-445-1011",
            "fax_number": "631-642-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117766000",
            "telephone_number": "631-828-4545",
            "fax_number": "631-642-1070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONASERA",
        "first_name": "GREGORY",
        "middle_name": "N.",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2018-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X005301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01738361",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Blake
• Lindsay Block, SLP
• Ruth Bochat, FNP-BC
• Courtney Rae Bochicchio
• Melissa Bonacci
• Katherine Ariel Bond, LPN
• Eileen Bordt, LPN
• Katie Melissa Born, M.A. CCC-CLP
• Varvara Boryushkina, MD
• Alexandra M Bosch

• Chiropractor in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.