Provider Demographics
NPI:1063456754
Name:BOXER, DOUGLAS C (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:BOXER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-0216
Mailing Address - Country:US
Mailing Address - Phone:973-535-1750
Mailing Address - Fax:973-535-1750
Practice Address - Street 1:1896 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:973-535-1750
Practice Address - Fax:973-535-1750
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA070149002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ049434A2VOtherMEDICARE
NJ8517908Medicaid
2049040000OtherAMERIHEALTH
2K7280OtherHEALTHNET
P00151060OtherRAILROAD CARE
2049040000OtherAMERIHEALTH
NJ049434A2VOtherMEDICARE