Provider Demographics
NPI:1760446918
Name:GILLARD, BONITA D (MD)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:D
Last Name:GILLARD
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 1:76 STIRLING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5751
Mailing Address - Country:US
Mailing Address - Phone:908-755-5437
Mailing Address - Fax:908-755-6905
Practice Address - Street 1:76 STIRLING RD
Practice Address - Street 2:STE 201
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5751
Practice Address - Country:US
Practice Address - Phone:908-755-5437
Practice Address - Fax:908-755-6905
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06487000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2355128OtherAETNA HMO
NJ7963143OtherAETNA PPO
NJK5537OtherBCBS NJ HMO
NJ5572016011OtherCIGNA
NJP2173649OtherOXFORD
NJ2319999000OtherAMERIHEALTH HMO PIN
NJ25384OtherUNIVERSITY HEALTH PLAN