Provider Demographics
NPI:1114498367
Name:TANCHINGCO, BONIFACIO SUMBILLO (APN)
Entity Type:Individual
Prefix:MR
First Name:BONIFACIO
Middle Name:SUMBILLO
Last Name:TANCHINGCO
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RUBAR DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2506
Mailing Address - Country:US
Mailing Address - Phone:732-241-2586
Mailing Address - Fax:732-613-1192
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-507-8093
Practice Address - Fax:732-613-1192
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00877600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily