Provider Demographics
NPI:1841202181
Name:SANCHEZ, BONITO Y (MD)
Entity Type:Individual
Prefix:
First Name:BONITO
Middle Name:Y
Last Name:SANCHEZ
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 1:9 QUAKER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5129
Mailing Address - Country:US
Mailing Address - Phone:732-476-8804
Mailing Address - Fax:
Practice Address - Street 1:186 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1418
Practice Address - Country:US
Practice Address - Phone:732-418-0004
Practice Address - Fax:732-545-1185
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03262900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ459681Medicare ID - Type Unspecified
NJB12239Medicare UPIN