Provider Demographics
NPI:1780134635
Name:BONACCI, MICHAEL (MS, LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BONACCI
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DEVONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2236
Mailing Address - Country:US
Mailing Address - Phone:609-751-4654
Mailing Address - Fax:609-228-5839
Practice Address - Street 1:20 NASSAU ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4509
Practice Address - Country:US
Practice Address - Phone:609-751-4654
Practice Address - Fax:609-228-5839
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00122400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist