Provider Demographics
NPI:1114188935
Name:BONNIE B KAZAM, MD, PA
Entity Type:Organization
Organization Name:BONNIE B KAZAM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-267-8585
Mailing Address - Street 1:2 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4220
Mailing Address - Country:US
Mailing Address - Phone:973-267-8585
Mailing Address - Fax:
Practice Address - Street 1:2 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4220
Practice Address - Country:US
Practice Address - Phone:973-267-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53336Medicare UPIN
NJ131368Medicare PIN