Provider Demographics
NPI:1497850895
Name:BONAVENTURA, LISA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:BONAVENTURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2345 LAMINGTON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2612
Mailing Address - Country:US
Mailing Address - Phone:908-781-9661
Mailing Address - Fax:908-781-2106
Practice Address - Street 1:2345 LAMINGTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2612
Practice Address - Country:US
Practice Address - Phone:908-781-9661
Practice Address - Fax:908-781-2106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA51694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13170Medicare UPIN