Provider Demographics
NPI:1366610974
Name:KATHRYN F. BONESE,MD,PC
Entity type:Organization
Organization Name:KATHRYN F. BONESE,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BONESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-777-5435
Mailing Address - Street 1:32 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6310
Mailing Address - Country:US
Mailing Address - Phone:203-777-5435
Mailing Address - Fax:
Practice Address - Street 1:32 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6310
Practice Address - Country:US
Practice Address - Phone:203-777-5435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty