Provider Demographics
NPI:1093404394
Name:BONNER, JASAUN JEROME ANTHONY SR
Entity Type:Individual
Prefix:
First Name:JASAUN
Middle Name:JEROME ANTHONY
Last Name:BONNER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SCHERMERHORN ST APT 423
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5894
Mailing Address - Country:US
Mailing Address - Phone:862-367-4423
Mailing Address - Fax:
Practice Address - Street 1:200 SCHERMERHORN ST APT 423
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5894
Practice Address - Country:US
Practice Address - Phone:862-367-4423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program