Provider Demographics
NPI:1144355124
Name:BUONO, THOMAS G (CDN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:BUONO
Suffix:
Gender:M
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CONNELLY RD
Mailing Address - Street 2:
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466-5013
Mailing Address - Country:US
Mailing Address - Phone:845-334-9388
Mailing Address - Fax:
Practice Address - Street 1:76 FIREMENS WAY
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6519
Practice Address - Country:US
Practice Address - Phone:845-382-1899
Practice Address - Fax:845-382-1935
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0018421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered