Provider Demographics
NPI:1699831560
Name:OCONNELL, BONNIE LYNN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6336
Mailing Address - Country:US
Mailing Address - Phone:631-549-1280
Mailing Address - Fax:631-549-1005
Practice Address - Street 1:709 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6336
Practice Address - Country:US
Practice Address - Phone:631-549-1280
Practice Address - Fax:631-549-1005
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20110POtherHIP
NY4309299OtherAETNA PROVIDER
NYQ51671Medicare ID - Type Unspecified