Provider Demographics
NPI:1316251119
Name:BONA DEA GYNECOLOGY, LLC.
Entity type:Organization
Organization Name:BONA DEA GYNECOLOGY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:B
Authorized Official - Last Name:VERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:551-278-5898
Mailing Address - Street 1:481 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1519
Mailing Address - Country:US
Mailing Address - Phone:551-278-5898
Mailing Address - Fax:551-236-1771
Practice Address - Street 1:481 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1519
Practice Address - Country:US
Practice Address - Phone:551-278-5898
Practice Address - Fax:551-236-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08210000207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty