Mary Ann Bonilla, M.D.

Primary specialty

Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X

License

25MA06328600 Issued in NJ

Practice address

703 Main St
St. Joseph's Regional Medical Center
Paterson, NJ 07503-2621

Phone

(973) 754-2000

NPI assigned

May 17, 2006

Last updated

Mar 8, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. Joseph's Healthcare, Inc.

  • Internal Medicine Physician
  • Paterson, NJ
  • NPI 1497791297
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362700800000",
    "number": "1316999154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 MAIN ST",
            "address_2": "ST. JOSEPH'S REGIONAL MEDICAL CENTER",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075032621",
            "telephone_number": "973-754-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 MAIN ST",
            "address_2": "ST. JOSEPH'S REGIONAL MEDICAL CENTER",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075032621",
            "telephone_number": "973-754-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "MARY ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2013-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "NJ",
            "license": "25MA06328600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7243405",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kishanrao Bogavelli, MD
• Maged Boghdady, M.D.
• Janardhan Bollu, MD
• Maryanne Bolton, DNP, RN., APN-BC
• Veera Jayasree Latha Bommu, MBBS
• Judith Bonjour, NP
• Serge Bontemps, MD
• Grace Boone
• Deniece Tamara Boothe, D.O.
• Charles S Borgen

• Pediatric Hematology & Oncology Physician in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Pediatric Hematology & Oncology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.