Individual
EDWIN A BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
354 SOUTH AVE E, WESTFIELD, NJ 07090-1788
(908) 233-8065
Mailing address
354 SOUTH AVE E, WESTFIELD, NJ 07090-1788
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR16611700
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ01308100
NJ
Other
Enumeration date
04/25/2022
Last updated
05/23/2022
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