Basic Information
| Provider Information | |||||||||
| NPI: | 1346202363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONDAR | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 LIPPINCOTT DR STE 410 | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080534197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563550340 | ||||||||
| FaxNumber: | 8563550330 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 WHITE HORSE PIKE STE 103B | ||||||||
| Address2: | |||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565463900 | ||||||||
| FaxNumber: | 8565463908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 057149 | GA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 25MA06839200 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 205778734003 | 01 | GA | TRICARE SOUTH REGION | OTHER | BB6197051 | 01 | GA | DEA | OTHER | DH1281 | 01 | GA | RAILROAD MEDICARE - GROUP # | OTHER | 057149 | 01 | GA | PHYSICIAN LICENSE # | OTHER | 11D0265294 | 01 | GA | CLIA ID - 1309 OCILLA RD STE A | OTHER | 246323146D | 05 | GA | MEDICAID | P00726013 | 01 | GA | RAILROAD MEDICARE - PTAN | OTHER | 11D1105865 | 01 | GA | CLIA ID - 17 JOHNSON ST | OTHER | 246323146E | 05 | GA | MEDICAID |