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General NPI Number Information
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NPI Number | 1992771349
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Entity Type | Individual
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Provider Name | LUIGI VITTORIO BONOMINI M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2006
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 767 NORTHFIELD AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1194
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Country | US
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Telephone | 973-419-0417
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Fax | 862-766-5904
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Provider Business Mailing Address
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Address Line | 767 NORTHFIELD AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1194
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Country | US
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Telephone | 973-419-0417
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Fax | 862-766-5904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 25MA064708000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1932-29
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 25MA06470800
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 1932-29
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License Number State | NY
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