Provider Demographics
NPI:1396738738
Name:BONGIOVANNI, DENISE ANN (DO)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANN
Last Name:BONGIOVANNI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MCKINLEY PL
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2420
Mailing Address - Country:US
Mailing Address - Phone:973-983-8433
Mailing Address - Fax:
Practice Address - Street 1:145 DIAMOND SPRING RD
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2720
Practice Address - Country:US
Practice Address - Phone:973-625-8888
Practice Address - Fax:973-625-7877
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB060530002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
785222AZCMedicare ID - Type Unspecified
G09249Medicare UPIN