Provider Demographics
NPI:1093231102
Name:BONITATIS, MONICA P
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:P
Last Name:BONITATIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E GLOUCESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1323
Mailing Address - Country:US
Mailing Address - Phone:856-547-4422
Mailing Address - Fax:856-547-0660
Practice Address - Street 1:50 E GLOUCESTER PIKE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1323
Practice Address - Country:US
Practice Address - Phone:856-547-4422
Practice Address - Fax:856-547-0660
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01734600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty