Provider Demographics
NPI:1740257732
Name:BONDER, IRVIN M (MD)
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:M
Last Name:BONDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1645
Mailing Address - Country:US
Mailing Address - Phone:973-895-6636
Mailing Address - Fax:973-895-5327
Practice Address - Street 1:333 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1645
Practice Address - Country:US
Practice Address - Phone:973-895-6636
Practice Address - Fax:973-895-5327
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04260000174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ535587BKGMedicare PIN
C60748Medicare UPIN