Edwin A Bonilla, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ01308100 Issued in NJ

Practice address

354 South Ave E
Westfield, NJ 07090-1788

Phone

(908) 233-8065

NPI assigned

Apr 25, 2022

Sex

Male

Sole proprietor

Yes

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

• Embrace Psychiatric Wellness Center

  • Psychiatry Physician
  • Westfield, NJ
  • NPI 1366742868
  NPD
• Lifebulb LLC

  • Mental Health Counselor
  • Toms River, NJ
  • NPI 1699491464
  NPD (past)
• Walgreen Eastern Co Inc

  • Pharmacy
  • Perth Amboy, NJ
  • NPI 1619982691
  NPD (past)
• Walgreen Eastern Co Inc

  • Pharmacy
  • Brookhaven, PA
  • NPI 1215942206
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 23, 2022.

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1972247104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 SOUTH AVE E",
            "city": "WESTFIELD",
            "state": "NJ",
            "postal_code": "070901788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 SOUTH AVE E",
            "city": "WESTFIELD",
            "state": "NJ",
            "postal_code": "070901788",
            "telephone_number": "908-233-8065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 Convery Blvd",
            "address_purpose": "LOCATION",
            "city": "Perth Amboy",
            "state": "NJ",
            "postal_code": "088613021",
            "country_code": "US",
            "telephone_number": "732-826-9222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "EDWIN",
        "middle_name": "A",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01308100",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR16611700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric S Boden, PT, MPT
• Bodhi Mind Centers
• Christine A Boffa, MS, OTR/L
• Leopold Jorge Bolona, MD
• Elizabeth Bongo, RD
• William Boulton Bonsall, D.C., D.A.C.B.S.P.
• Susan Valdes Borja, M.D.
• Jamie Bornstein, OTR/L
• Zaliyah B Boston
• Dan R. Bottorff, M.DIV.

• All providers in Westfield, NJ
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.