Provider Demographics
NPI:1942434188
Name:BONGAH, FRANCIS MORIE (APN, NP-C)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:MORIE
Last Name:BONGAH
Suffix:
Gender:M
Credentials:APN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:20 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1108
Mailing Address - Country:US
Mailing Address - Phone:862-849-2854
Mailing Address - Fax:862-849-2854
Practice Address - Street 1:741 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:973-676-1396
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00230300101YA0400X
NJ26NJ00132000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)