Chiropractic of Stony Brook PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

X005301-1 Issued in NY

Legal business name

CHIROPRACTIC OF STONY BROOK PLLC

Doing business as

PORT JEFF STATION CHIROPRACTIC

Practice address

1041 Rout 112
Port Jefferson Station, NY 11776

Phone

(631) 828-4545

Fax

(631) 642-1070

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gregory N. Bonasera, D.C.NPI 1841374352

Title

Member

Phone

(631) 828-4545

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• PORT JEFF STATION CHIROPRACTIC Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory N. Bonasera, DC

  • Chiropractor
  • Port Jefferson Station, NY
  • NPI 1841374352
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548115200000",
    "number": "1891838538",
    "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": "631-828-4545",
            "fax_number": "631-642-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 ROUT 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-828-4545",
            "fax_number": "631-642-1070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC OF STONY BROOK PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2019-01-22",
        "status": "A",
        "authorized_official_last_name": "BONASERA",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "631-828-4545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "X005301-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01738361",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORT JEFF STATION CHIROPRACTIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Changing Seasons Counseling LCSW PLLC
• Hira Chaudhary
• Aziz Chaudry, MD
• Varghese Cherian, M.D.
• Christopher Chiarelli
• Ajay Earl Chitkara, M.D.
• Sun Lan Choi
• Bonny Chrystal, RN
• David Tin Chu, M.D.
• Celeste Ciabattari

• Clinic/Center in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.