Provider Demographics
NPI:1104182716
Name:BONITZ, ROBERT PAUL JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PAUL
Last Name:BONITZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 SHREWSBURY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4159
Mailing Address - Country:US
Mailing Address - Phone:732-741-5923
Mailing Address - Fax:732-741-2759
Practice Address - Street 1:595 SHREWSBURY AVE STE 103
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4159
Practice Address - Country:US
Practice Address - Phone:732-741-5923
Practice Address - Fax:732-741-2759
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10114100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program