Provider Demographics
NPI:1669556692
Name:BONENBERGER, HOWARD JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JOHN
Last Name:BONENBERGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVERSIDE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1304
Mailing Address - Country:US
Mailing Address - Phone:603-882-8866
Mailing Address - Fax:603-882-8968
Practice Address - Street 1:17 RIVERSIDE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1304
Practice Address - Country:US
Practice Address - Phone:603-882-8866
Practice Address - Fax:603-882-8968
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0181213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0308266Y0NH01OtherANTHEM LEGACY NUMBER
NH30364060Medicaid
NH0308266Y0NH01OtherANTHEM LEGACY NUMBER
NHNH8266Medicare ID - Type Unspecified