Healthcare Provider Details

I. General information

NPI: 1104270917
Provider Name (Legal Business Name): ELIZABETH MARY BONARIGO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST STE 405
HACKENSACK NJ
07601-3247
US

IV. Provider business mailing address

449 OLD STONE RD
RIDGEWOOD NJ
07450-1416
US

V. Phone/Fax

Practice location:
  • Phone: 201-919-1343
  • Fax: 201-603-1812
Mailing address:
  • Phone: 585-409-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00364200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: