Provider Demographics
NPI:1700112604
Name:BONFIGLIO, DENNIS (RNFA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BONFIGLIO
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 HARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3809
Mailing Address - Country:US
Mailing Address - Phone:609-829-2858
Mailing Address - Fax:
Practice Address - Street 1:645 HARBOR AVE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3809
Practice Address - Country:US
Practice Address - Phone:609-829-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11629400163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant