Provider Demographics
NPI:1669504478
Name:FENYAR, BONNIE ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE ANN
Middle Name:MARIE
Last Name:FENYAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 COVE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4719
Mailing Address - Country:US
Mailing Address - Phone:732-929-3145
Mailing Address - Fax:732-929-1516
Practice Address - Street 1:47 COVE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4719
Practice Address - Country:US
Practice Address - Phone:732-929-3145
Practice Address - Fax:732-929-1516
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06489800207R00000X, 2084F0202X, 2084P0800X
MI4301073535207R00000X, 2084F0202X, 2084P0800X
MT11149207R00000X, 2084F0202X, 2084P0800X
OH89148207R00000X, 2084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7176902Medicaid
NJ7176902Medicaid
NJFE651840Medicare PIN