Healthcare Provider Details

I. General information

NPI: 1013902345
Provider Name (Legal Business Name): HOWARD J BONENBERGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RIVERSIDE ST #205
NASHUA NH
03062-1373
US

IV. Provider business mailing address

17 RIVERSIDE ST #205
NASHUA NH
03062-1373
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-8866
  • Fax: 603-882-8968
Mailing address:
  • Phone: 603-882-8866
  • Fax: 603-882-8968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0181
License Number StateNH

VIII. Authorized Official

Name: DR. HOWARD JOHN BONENBERGER
Title or Position: OWNER
Credential: DPM
Phone: 603-882-8866