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General NPI Number Information
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NPI Number | 1225540719
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Entity Type | Organization
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Legal Business Name | NEW JERSEY TOTALHEALTH MEDICALS P.A.
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 209 S LIVINGSTON AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4044
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Country | US
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Telephone | 973-992-8189
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Fax |
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Provider Business Mailing Address
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Address Line | 209 S LIVINGSTON AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BONNEY CAI-LUO
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Credential | MD
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Telephone | 973-992-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA72322
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA72322
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License Number State | NJ
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