Premier Pediatric Cardiology LLC

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

25MA08663900 Issued in NJ

Legal business name

PREMIER PEDIATRIC CARDIOLOGY LLC

Practice address

750 Route 73 S
Marlton, NJ 08053-4141

Phone

(856) 872-2868

Fax

(856) 872-2876

NPI assigned

Apr 9, 2016

Organization subpart

No

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

Authorized official

Name

Dr. William Bonney, M.D.NPI 1790801371

Title

Ceo

Phone

(856) 872-2868

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, PA2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William James Bonney, M.D.

  • Pediatric Cardiology Physician
  • Marlton, NJ
  • NPI 1790801371

  PA

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1460160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1962866566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 E LANCASTER AVE",
            "address_2": "#334",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190961929",
            "telephone_number": "856-872-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 ROUTE 73 S",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534141",
            "telephone_number": "856-872-2868",
            "fax_number": "856-872-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PEDIATRIC CARDIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-09",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "BONNEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "856-872-2868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NJ",
            "license": "25MA08663900",
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "PA",
            "license": "MD436538",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Cardiology Physician in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Pediatric Cardiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.