Provider Demographics
NPI:1841371028
Name:LEVIN, BONNIE LORRAINE (DO)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LORRAINE
Last Name:LEVIN
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 1:1020 KINGS HWY N STE 105
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1939
Mailing Address - Country:US
Mailing Address - Phone:856-667-3948
Mailing Address - Fax:856-321-8326
Practice Address - Street 1:1020 KINGS HWY N STE 105
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1939
Practice Address - Country:US
Practice Address - Phone:856-667-3948
Practice Address - Fax:856-321-8326
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05002400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2271702Medicaid
NJ2311851OtherAETNA
NJ522235995OtherHORIZON BC/BS
NJ0790383001OtherAMERIHEALTH
NJ1134833OtherHORIZON MERCY
NJ522235995OtherHORIZON BC/BS
NJ2271702Medicaid
NJ0790383001OtherAMERIHEALTH