Healthcare Provider Details

I. General information

NPI: 1639231723
Provider Name (Legal Business Name): BONNIE JOY BIRNBAUM RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE JOY AMSTERDAM RD

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DUNHAMS CORNER RD
EAST BRUNSWICK NJ
08816-3532
US

IV. Provider business mailing address

3 MAYFAIR CT
EAST BRUNSWICK NJ
08816-3508
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-0113
  • Fax:
Mailing address:
  • Phone: 732-651-7224
  • Fax: 732-651-9856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: