Provider Demographics
NPI:1508906371
Name:BONDI, JACK M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:BONDI
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:438 GANTTOWN RD
Mailing Address - Street 2:SUITE B4
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2341
Mailing Address - Country:US
Mailing Address - Phone:856-589-0990
Mailing Address - Fax:856-589-3254
Practice Address - Street 1:438 GANTTOWN RD
Practice Address - Street 2:SUITE B4
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2341
Practice Address - Country:US
Practice Address - Phone:856-589-0990
Practice Address - Fax:856-589-3254
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMD002247213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU51490Medicare UPIN