Provider Demographics
NPI:1962795427
Name:BONNIE NYE MD, LLC
Entity type:Organization
Organization Name:BONNIE NYE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-458-8488
Mailing Address - Street 1:163 POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9518
Mailing Address - Country:US
Mailing Address - Phone:610-458-8488
Mailing Address - Fax:610-458-6465
Practice Address - Street 1:163 POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9518
Practice Address - Country:US
Practice Address - Phone:610-458-8488
Practice Address - Fax:610-458-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044562L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty