Provider Demographics
NPI:1346344868
Name:ANTHONY J BONI OD AND ALICIA N DORMAN OD/PA
Entity Type:Organization
Organization Name:ANTHONY J BONI OD AND ALICIA N DORMAN OD/PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-785-3277
Mailing Address - Street 1:245 PATERSON AVE
Mailing Address - Street 2:PO BOX 1220
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1607
Mailing Address - Country:US
Mailing Address - Phone:973-785-3277
Mailing Address - Fax:973-812-1723
Practice Address - Street 1:245 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1607
Practice Address - Country:US
Practice Address - Phone:973-785-3277
Practice Address - Fax:973-812-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0619960001Medicare NSC
NJBO528730Medicare ID - Type Unspecified