Provider Demographics
NPI:1528078797
Name:BONAKER, LAURA J (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:BONAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 N FRANKLIN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2547
Mailing Address - Country:US
Mailing Address - Phone:609-272-0655
Mailing Address - Fax:609-272-9188
Practice Address - Street 1:22 N FRANKLIN BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2547
Practice Address - Country:US
Practice Address - Phone:609-272-9040
Practice Address - Fax:609-272-9055
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03906000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2300001Medicaid
035725Medicare ID - Type UnspecifiedMCR NUMBER
NJ2300001Medicaid