Provider Demographics
NPI:1083699409
Name:BONALA, SAVITHRI B (M D)
Entity Type:Individual
Prefix:DR
First Name:SAVITHRI
Middle Name:B
Last Name:BONALA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2408
Mailing Address - Country:US
Mailing Address - Phone:732-545-0094
Mailing Address - Fax:732-545-4087
Practice Address - Street 1:18 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2408
Practice Address - Country:US
Practice Address - Phone:732-545-0094
Practice Address - Fax:732-545-4087
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79314207KA0200X
NJ25MA073362000207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3239782OtherOXFORD
NJ38150OtherUNIVERSITY HEALTH PLAN
NJ60006198OtherHORIZON NJ HEALTH
NJ1603R1OtherEMPIRE BCBS
NJ236325OtherAMERIGROUP
NJ2099742OtherGHI
NJ2K7611OtherHEALTHNET
NJ7366552OtherAETNA
NJ0071684Medicaid
NJ0150142000OtherAMERIHEALTH
NJ8828709Medicaid
NJ2421092OtherUNITED HEALTHCARE
NJ1605318OtherCIGNA
NJ91001540100OtherAMERICHOICE
NJ8828709Medicaid
NJ0071684Medicaid