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General NPI Number Information
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NPI Number | 1710259536
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Entity Type | Organization
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Legal Business Name | DR. BONNIE LLC
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 1020 N KINGS HWY SUITE 208
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1906
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Country | US
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Telephone | 856-216-1509
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Fax | 856-216-1509
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Provider Business Mailing Address
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Address Line | 1020 KINGS HWY N STE 105
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1939
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Country | US
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Telephone | 856-667-3947
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Fax | 856-321-8326
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | BONNIE LEVIN
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Credential | D.O.
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Telephone | 856-667-3948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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