Healthcare Provider Details

I. General information

NPI: 1801947973
Provider Name (Legal Business Name): DENISE BONNIN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WILLS WAY
PISCATAWAY NJ
08854
US

IV. Provider business mailing address

12 WILLS WAY
PISCATAWAY NJ
08854
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-3833
  • Fax:
Mailing address:
  • Phone: 732-968-3833
  • Fax: 732-968-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00290000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: