MEDICARE: DR. JAY S BONOVITZ

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
1	2084P0800X	Psychiatry Physician	MD014885E	PA

General Provider Information

NPI Number	:	1174598130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY S BONOVITZ

Provider Business Mailing Address
First Line	:	214 DERWEN RD
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1207
Country	:	US
Telephone Number	:	610-664-3785
Fax Number	:	610-664-5647

Provider Business Practice Location Address
First Line	:	214 DERWEN RD
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1207
Country	:	US
Telephone Number	:	610-664-3785
Fax Number	:	610-664-5647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. JAY S BONOVITZ ” Practice Location

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