Provider Demographics
NPI:1992711550
Name:BON-CLIFF
Entity type:Organization
Organization Name:BON-CLIFF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BONIFACE
Authorized Official - Middle Name:O
Authorized Official - Last Name:EGUZOUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-786-1462
Mailing Address - Street 1:56 SCHELLER ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:PA
Mailing Address - Zip Code:17560
Mailing Address - Country:US
Mailing Address - Phone:717-786-1462
Mailing Address - Fax:717-786-9135
Practice Address - Street 1:56 SCHELLER ROAD
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:PA
Practice Address - Zip Code:17560
Practice Address - Country:US
Practice Address - Phone:717-786-1462
Practice Address - Fax:717-786-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012398810001Medicaid
PA1012398810001Medicaid