Provider Demographics
NPI:1962587543
Name:BONIFACE ORTHOPAEDICS, INC.
Entity type:Organization
Organization Name:BONIFACE ORTHOPAEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BONIFACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-4399
Mailing Address - Street 1:835 MCKAY CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5786
Mailing Address - Country:US
Mailing Address - Phone:330-758-4399
Mailing Address - Fax:330-799-8995
Practice Address - Street 1:835 MCKAY CT
Practice Address - Street 2:SUITE 100
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5786
Practice Address - Country:US
Practice Address - Phone:330-758-4399
Practice Address - Fax:330-799-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0170960001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701173Medicaid
OH0701182Medicaid
OH0929142Medicaid
OH0929142Medicaid
OH0701173Medicaid
OHBO0736063Medicare ID - Type Unspecified
OHBO0613201Medicare ID - Type Unspecified
OHBO0613083Medicare ID - Type Unspecified
OH0701182Medicaid