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NPI Code Detail

MEDICARE: ANGELA BONNIE LEE DO

MEDICARE: ANGELA BONNIE LEE DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician25MB10719600NJ

General Provider Information

NPI Number : 1053848382
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA BONNIE LEE DO
Provider Business Mailing Address
First Line : 384 COUNTY ROAD 513
Second Line :
City : CALIFON
State : NJ
Zip : 07830-4158
Country : US
Telephone Number : 908-832-2125
Fax Number :
Provider Business Practice Location Address
First Line : 384 COUNTY ROAD 513
Second Line :
City : CALIFON
State : NJ
Zip : 07830-4158
Country : US
Telephone Number : 908-832-2125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2017
Last Update Date : 05/19/2021

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Directions to “ ANGELA BONNIE LEE DO” Practice Location

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