Provider Demographics
NPI:1053378943
Name:BUONO, TAMARA (DC)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:BUONO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-4208
Mailing Address - Country:US
Mailing Address - Phone:518-372-9106
Mailing Address - Fax:518-372-3105
Practice Address - Street 1:3610 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-4208
Practice Address - Country:US
Practice Address - Phone:518-372-9106
Practice Address - Fax:518-372-3105
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008605-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB3100Medicare PIN