Healthcare Provider Details

I. General information

NPI: 1245560770
Provider Name (Legal Business Name): BONNIE LENDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WOODLAND ST STE 311
HARTFORD CT
06105-4318
US

IV. Provider business mailing address

40 GARDEN ST
MANCHESTER CT
06040-5001
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-6745
  • Fax: 860-293-2021
Mailing address:
  • Phone: 860-841-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002347
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: