1760446918 NPI number — BONITA D GILLARD MD

Table of content: BONITA D GILLARD MD (NPI 1760446918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760446918 NPI number — BONITA D GILLARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLARD
Provider First Name:
BONITA
Provider Middle Name:
D
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:
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:
1760446918
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:
76 STIRLING RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07059-5751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-755-5437
Provider Business Mailing Address Fax Number:
908-755-6905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 STIRLING RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07059-5751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-755-5437
Provider Business Practice Location Address Fax Number:
908-755-6905
Provider Enumeration Date:
04/14/2006

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: 208000000X , with the licence number:  25MA06487000 , 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: 2355128 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7963143 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: K5537 . This is a "BCBS NJ HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5572016011 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2173649 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2319999000 . This is a "AMERIHEALTH HMO PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25384 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com