1285054122 NPI number — VICTORIA M BONES MD

Table of content: VICTORIA M BONES MD (NPI 1285054122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285054122 NPI number — VICTORIA M BONES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONES
Provider First Name:
VICTORIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STUSS
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285054122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 ROUTE 33
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-280-7855
Provider Business Mailing Address Fax Number:
732-280-7815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 ROUTE 33
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-769-3217
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2014

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: 207Y00000X , with the licence number:  25MA10483700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25MA10483700 . This is a "NJ MEDICAL LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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