Provider Demographics
NPI:1376548172
Name:BOXMAN, JEFFREY R (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:BOXMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:436 CHRIS GAUPP DR
Mailing Address - Street 2:STE 104
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4487
Mailing Address - Country:US
Mailing Address - Phone:609-748-6696
Mailing Address - Fax:609-748-6693
Practice Address - Street 1:436 CHRIS GAUPP DR
Practice Address - Street 2:STE 104
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4487
Practice Address - Country:US
Practice Address - Phone:609-748-6696
Practice Address - Fax:609-748-6693
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB060072002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ021197Medicare ID - Type Unspecified
NJG82452Medicare UPIN