Lisa Marie Bonaventura, M.D.
Individual provider Active NPI Internal Medicine Physician · Bedminster, NJ
NPI 1497850895 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497850895
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MA51694 (NJ)
- Practice address
- 2345 Lamington Rd
Suite 104
Bedminster, NJ 07921-2612 - Phone
- (908) 781-9661
- Fax
- (908) 781-2106
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051017000660 | NJ | Practitioner - Internal Medicine | 1355367699 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA51694 | NJ | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MA51694 | NJ | Yes |
Addresses
Primary practice location
2345 Lamington Rd
Suite 104
Bedminster, NJ 07921-2612
Mailing address
2345 Lamington Rd
Suite 104
Bedminster, NJ 07921-2612
Phone (908) 781-9661
Other providers in Bedminster, NJ
- Bedminster Homecare PT
- Bedminster Orthopaedics & Sports Medicine PA
- Bedminster Specialty Pharmacy Inc.
- Better Wellness Counseling and Consulting LLC
- Anita Bhavnani
- Corey Scott Bosin
- Felicia Bradley
- Robert Laurie Branch
- Bridges Counseling Center for Child & Family Wellness at Bedminster
- Bridget Nash
All providers in Bedminster, NJ · Internal Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.