1063456754 NPI number — DOUGLAS C BOXER MD

Table of content: DOUGLAS C BOXER MD (NPI 1063456754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063456754 NPI number — DOUGLAS C BOXER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOXER
Provider First Name:
DOUGLAS
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063456754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLBURN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07041-0216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-535-1750
Provider Business Mailing Address Fax Number:
973-535-1750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1896 MORRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-535-1750
Provider Business Practice Location Address Fax Number:
973-535-1750
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  25MA07014900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 049434A2V . This is a "MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8517908 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2049040000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K7280 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00151060 . This is a "RAILROAD CARE" identifier . This identifiers is of the category "OTHER".




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