Provider Demographics
NPI:1881641025
Name:CAI-LUO, BONNEY D (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNEY
Middle Name:D
Last Name:CAI-LUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANHUA
Other - Middle Name:
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:209 S LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4044
Mailing Address - Country:US
Mailing Address - Phone:973-992-8189
Mailing Address - Fax:
Practice Address - Street 1:209 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4044
Practice Address - Country:US
Practice Address - Phone:973-992-8189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72322207R00000X, 207RA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8926603Medicaid
054187BASMedicare ID - Type Unspecified
NJ8926603Medicaid