1023078060 NPI number — DR. JOSEPH LOUIS BONINA D.C.

Table of content: DR. JOSEPH LOUIS BONINA D.C. (NPI 1023078060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023078060 NPI number — DR. JOSEPH LOUIS BONINA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONINA
Provider First Name:
JOSEPH
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023078060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 ROUTE 28
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST YARMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02673-4719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-790-4100
Provider Business Mailing Address Fax Number:
508-790-4111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 ROUTE 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST YARMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02673-4719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-790-4100
Provider Business Practice Location Address Fax Number:
508-790-4111
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  MA1343 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y39483 . This is a "BCBSMA GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y35965 . This is a "BCBSMA INDIV.#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 35271 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 596100 . This is a "CIGNA HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 001343 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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