Provider Demographics
NPI:1336140920
Name:BONIER, BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BONIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 LINCOLN DR W
Mailing Address - Street 2:STE F
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1522
Mailing Address - Country:US
Mailing Address - Phone:856-985-2001
Mailing Address - Fax:
Practice Address - Street 1:5001 LINCOLN DR W
Practice Address - Street 2:STE F
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1522
Practice Address - Country:US
Practice Address - Phone:856-985-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB061590002085R0202X
PAOS004560L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0092645401OtherAMERICHOICE
PA0057308000OtherINDEPENDENCE BLUE CROSS
PA15771OtherHEALTH PARTNERS
PA1017661OtherKEYSTONE MERCY
PA300064533OtherRR MEDICARE
PA092284OtherHIGHMARK
PA000926454Medicaid
PA8321OtherBRAVO ELDER HEALTH
PA300064533OtherRR MEDICARE
PA8321OtherBRAVO ELDER HEALTH