Provider Demographics
NPI:1114097722
Name:HESS BONDI LLC
Entity Type:Organization
Organization Name:HESS BONDI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-589-0990
Mailing Address - Street 1:438 GANTTOWN RD
Mailing Address - Street 2:STE B4
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-589-0990
Mailing Address - Fax:856-589-3254
Practice Address - Street 1:438 GANTTOWN RD
Practice Address - Street 2:STE B4
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-589-0990
Practice Address - Fax:856-589-3254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01175213E00000X
NJMD002247213E00000X
NJMD002786213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2982706Medicaid
NJDC6865OtherMEDICARE RAILROAD
NJDC6865OtherMEDICARE RAILROAD
T73091Medicare UPIN