Provider Demographics
NPI:1083823827
Name:BONIFACIO, DON LENNIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DON LENNIN
Middle Name:
Last Name:BONIFACIO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 JAMAICA BLVD
Mailing Address - Street 2:PLAZA 1, UNIT 21
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3758
Mailing Address - Country:US
Mailing Address - Phone:973-773-9990
Mailing Address - Fax:973-773-7772
Practice Address - Street 1:730 JAMAICA BLVD
Practice Address - Street 2:PLAZA 1, UNIT 21
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3758
Practice Address - Country:US
Practice Address - Phone:973-773-9990
Practice Address - Fax:973-773-7772
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00725500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089176T09Medicare UPIN