Provider Demographics
NPI:1922317866
Name:BONACCI, JOSEPH (MS, LAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:BONACCI
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NASSAU ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-4509
Mailing Address - Country:US
Mailing Address - Phone:609-751-4654
Mailing Address - Fax:
Practice Address - Street 1:20 NASSAU ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4509
Practice Address - Country:US
Practice Address - Phone:609-751-4654
Practice Address - Fax:609-228-5839
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00077500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist