Provider Demographics
NPI:1578665915
Name:MOISE, BONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BONARD
Middle Name:
Last Name:MOISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WISHNOW WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1481
Mailing Address - Country:US
Mailing Address - Phone:908-252-0553
Mailing Address - Fax:
Practice Address - Street 1:6 WISHNOW WAY
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1481
Practice Address - Country:US
Practice Address - Phone:908-252-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA063213002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ730695C2FOtherMEDICARE BILLING NO.
NJ730695C2FOtherMEDICARE BILLING NO.