Healthcare Provider Details

I. General information

NPI: 1942422266
Provider Name (Legal Business Name): PHYSICAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 WEST SHERMAN AVENUE
VINELAND NJ
08360
US

IV. Provider business mailing address

1237 WEST SHERMAN AVENUE
VINELAND NJ
08360
US

V. Phone/Fax

Practice location:
  • Phone: 856-896-2008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA06316600
License Number StateNJ

VIII. Authorized Official

Name: FRANCIS BONNER
Title or Position: OWNER
Credential: M.D.
Phone: 856-896-2008