Healthcare Provider Details

I. General information

NPI: 1215817937
Provider Name (Legal Business Name): BONLEVEN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W SPRING VALLEY AVE STE 102
MAYWOOD NJ
07607-1444
US

IV. Provider business mailing address

255 W SPRING VALLEY AVE STE 102
MAYWOOD NJ
07607-1444
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-8060
  • Fax: 201-301-8892
Mailing address:
  • Phone: 201-880-8060
  • Fax: 201-301-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NILAY SHAH
Title or Position: MD
Credential: MD
Phone: 201-880-8060