MEDICARE: EMILY TAYLOR BONNES PA-C

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	363AM0700X	Medical Physician Assistant	00210100	NJ

General Provider Information

NPI Number	:	1639322720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY TAYLOR BONNES PA-C

Provider Business Mailing Address
First Line	:	928 SPRUCE ST
Second Line	:	APT 2R
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6167
Country	:	US
Telephone Number	:	804-240-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 WHITEHORSE MERCERVILLE RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3814
Country	:	US
Telephone Number	:	609-581-1700
Fax Number	:

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

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	10/27/2009

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