Provider Demographics
NPI:1427059914
Name:BONETT, ANTHONY W (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:BONETT
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 1:50 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4618
Mailing Address - Country:US
Mailing Address - Phone:856-848-8081
Mailing Address - Fax:856-848-1577
Practice Address - Street 1:50 COOPER ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4618
Practice Address - Country:US
Practice Address - Phone:856-848-8081
Practice Address - Fax:856-848-1577
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1013769OtherHORIZON MERCY ID#
NJ221890307OtherHORIZON BC/BS
NJ0540350000OtherAMERIHEALTH ID NUMBER
NJ080038612OtherRAILROAD MEDICARE ID#
NJ4516702Medicaid
NJ0010148OtherAETNA USHC
NJ010002384OtherAMERICHOICE ID#
NJ4516702Medicaid
NJ0540350000OtherAMERIHEALTH ID NUMBER