Provider Demographics
NPI:1922090802
Name:GUERIN, BONNI LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNI
Middle Name:LEE
Last Name:GUERIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BONNI
Other - Middle Name:LEE
Other - Last Name:GEARHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:77 BRANT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066
Mailing Address - Country:US
Mailing Address - Phone:732-382-0091
Mailing Address - Fax:
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:THE CANCER CENTER AT OVERLOOK
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-608-0078
Practice Address - Fax:908-608-1504
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA75828207RH0003X
NJ25MA04582800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004651Medicaid
NJF48011Medicare UPIN
NJ0004651Medicaid