Individual
R-PHINNE SUPENA BONIFACIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
730 JAMAICA BLVD PLAZA 1, UNIT 21, TOMS RIVER, NJ 08757-3758
(732) 349-0008
Mailing address
730 JAMAICA BLVD STE 21, TOMS RIVER, NJ 08757-3758
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
40QA00738700
NJ
Other
Enumeration date
02/12/2008
Last updated
02/12/2008
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