| Doctor Name: | MR. JUSTIN J BONACCI |
| NPI Number: | 1700865136 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 017345-1 |
| Business Practice Address: | 1133 Montauk Hwy Mastic, NY - 119502918 |
| Business Phone Number: | 6314674235 |
| Business Fax Number: | 6314672655 |
| Mailing Address: | 4 Quincy St, PORT JEFFERSON STATION |
| State: | NY |
| Postal Code: | 117763420 |
| Phone Number: | 6314674235 |
| Fax Number: | 6314672655 |
| NPI Enumeration Date: | 01/13/2006 |
| NPI Last Update Date: | 01/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 017345-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |