Active NPI
Thomas P Bonazinga, M.D.
- Neurology Physician
- Freehold, NJ
National Provider Identifier
1912041252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- MA054713
- Practice address
- 1000 W Main St
Freehold, NJ 07728-2521 - Phone
- (732) 303-1144
- NPI assigned
- Feb 19, 2007
- Last updated
- Jun 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | MA054713 | NJ | Primary |
Addresses
Primary practice location
1000 W Main St
Freehold, NJ 07728-2521
Mailing address
1000 W Main St
Freehold, NJ 07728-2521
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5003105 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA054713 | NJ | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308700800000",
"number": "1912041252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 W MAIN ST",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 W MAIN ST",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282521",
"telephone_number": "732-303-1144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONAZINGA",
"first_name": "THOMAS",
"middle_name": "P",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-19",
"last_updated": "2011-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NJ",
"license": "MA054713",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5003105",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Freehold, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.