Provider Demographics
NPI:1932521549
Name:BONILLA, JOSUE (RV)
Entity type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:
Last Name:BONILLA
Suffix:
Gender:M
Credentials:RV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 PASADENA AVE
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-2317
Mailing Address - Country:US
Mailing Address - Phone:201-290-8111
Mailing Address - Fax:
Practice Address - Street 1:337 PASADENA AVE
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-2317
Practice Address - Country:US
Practice Address - Phone:201-290-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health