Provider Demographics
NPI:1639231723
Name:BIRNBAUM, BONNIE JOY (RD)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JOY
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JOY
Other - Last Name:AMSTERDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3 MAYFAIR CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3508
Mailing Address - Country:US
Mailing Address - Phone:732-651-7224
Mailing Address - Fax:732-651-9856
Practice Address - Street 1:123 DUNHAMS CORNER RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3532
Practice Address - Country:US
Practice Address - Phone:732-254-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
098252Medicare ID - Type UnspecifiedNUTRITIONIST