Jaclyn Marie Bonventre Valid NPI

Individual provider · Specialist · Center Moriches, NY

NPI

1114361219

Type

Individual (Type 1)

Primary specialty

Specialist

Specialty group

Other Service Providers

Taxonomy code

174400000X

License number

484461041 (NY)

Sex

Female

Sole proprietor

No

Enumerated

2013-04-20

Last updated

2013-09-05