Provider Demographics
NPI:1710259536
Name:DR. BONNIE LLC
Entity Type:Organization
Organization Name:DR. BONNIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-667-3948
Mailing Address - Street 1:1020 KINGS HWY N STE 105
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1939
Mailing Address - Country:US
Mailing Address - Phone:856-667-3947
Mailing Address - Fax:856-321-8326
Practice Address - Street 1:1020 N KINGS HWY
Practice Address - Street 2:SUITE 208
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1906
Practice Address - Country:US
Practice Address - Phone:856-216-1509
Practice Address - Fax:856-216-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13136Medicare UPIN