MEDICARE: BRUCE BONIER 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
1	2085R0202X	Diagnostic Radiology Physician	25MB06159000	NJ
2	2085R0202X	Diagnostic Radiology Physician	OS004560L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	300064533	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0092645401	OTHER	PA	AMERICHOICE
2	0057308000	OTHER	PA	INDEPENDENCE BLUE CROSS
3	15771	OTHER	PA	HEALTH PARTNERS
4	1017661	OTHER	PA	KEYSTONE MERCY
6	092284	OTHER	PA	HIGHMARK
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	8321	OTHER	PA	BRAVO ELDER HEALTH

General Provider Information

NPI Number	:	1336140920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE BONIER DO

Provider Business Mailing Address
First Line	:	5001 LINCOLN DR W
Second Line	:	STE F
City	:	MARLTON
State	:	NJ
Zip	:	08053-1522
Country	:	US
Telephone Number	:	856-985-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 LINCOLN DR W
Second Line	:	STE F
City	:	MARLTON
State	:	NJ
Zip	:	08053-1522
Country	:	US
Telephone Number	:	856-985-2001
Fax Number	:

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	09/26/2007

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Directions to “ BRUCE BONIER DO” Practice Location

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