Provider Demographics
NPI:1104270917
Name:BONARIGO, ELIZABETH MARY (DPM)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARY
Last Name:BONARIGO
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 OLD STONE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1416
Mailing Address - Country:US
Mailing Address - Phone:585-409-6720
Mailing Address - Fax:
Practice Address - Street 1:211 ESSEX ST STE 405
Practice Address - Street 2:
Practice Address - City:HACKENSACK,
Practice Address - State:NJ
Practice Address - Zip Code:07601-3247
Practice Address - Country:US
Practice Address - Phone:201-919-1343
Practice Address - Fax:201-603-1812
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MD00364200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program