Healthcare Provider Details

I. General information

NPI: 1922090802
Provider Name (Legal Business Name): BONNI LEE GUERIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNI LEE GEARHART MD

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE THE CANCER CENTER AT OVERLOOK
SUMMIT NJ
07901
US

IV. Provider business mailing address

77 BRANT AVE SUITE 200
CLARK NJ
07066
US

V. Phone/Fax

Practice location:
  • Phone: 908-608-0078
  • Fax: 908-608-1504
Mailing address:
  • Phone: 732-382-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA75828
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA04582800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: