Provider Demographics
NPI:1790801371
Name:BONNEY, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:BONNEY
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 1:750 ROUTE 73 S
Mailing Address - Street 2:SUITE 310A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4141
Mailing Address - Country:US
Mailing Address - Phone:856-872-2868
Mailing Address - Fax:856-872-2876
Practice Address - Street 1:750 ROUTE 73 S
Practice Address - Street 2:SUITE 310A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4141
Practice Address - Country:US
Practice Address - Phone:856-872-2868
Practice Address - Fax:856-872-2876
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA086639002080P0202X
PAMD4365382080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0192465Medicaid
PA1022894110001Medicaid
PA155089Medicare PIN
NJ244577Medicare PIN