MRS. Jaclyn Marie Bonventre

NPI #1114361219 in Center Moriches, New York

Provider Information

NPI Number: 1114361219
Entity Type: Individual
Name: MRS. Jaclyn Marie Bonventre
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Apr 20, 2013
Last Updated: Sep 5, 2013

Practice Location

Address: 18 CYNTHIA LN
City: Center Moriches
State: New York
ZIP Code: 11934-2602
Phone: (631) 909-2065

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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