Provider Demographics
NPI:1902404486
Name:BONI, JENNA LIN (APN-C)
Entity type:Individual
Prefix:
First Name:JENNA LIN
Middle Name:
Last Name:BONI
Suffix:
Gender:
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MALAPARDIS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1121
Mailing Address - Country:US
Mailing Address - Phone:973-240-5000
Mailing Address - Fax:973-765-9366
Practice Address - Street 1:210 MALAPARDIS RD STE 202
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1121
Practice Address - Country:US
Practice Address - Phone:973-240-5000
Practice Address - Fax:973-765-9366
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01066100363LA2100X, 363LA2200X, 363LC0200X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine