MEDICARE: THOMAS P BONAZINGA M.D.

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	2084N0400X	Neurology Physician	MA054713	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912041252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS P BONAZINGA M.D.

Provider Business Mailing Address
First Line	:	1000 W MAIN ST
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W MAIN ST
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2521
Country	:	US
Telephone Number	:	732-303-1144
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	06/22/2011

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