Provider Demographics
NPI:1629075064
Name:BOAK, JOSEPH G JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:BOAK
Suffix:JR
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 249
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0249
Mailing Address - Country:US
Mailing Address - Phone:732-741-3600
Mailing Address - Fax:732-741-6079
Practice Address - Street 1:4 HARTFORD DR
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4929
Practice Address - Country:US
Practice Address - Phone:732-741-3600
Practice Address - Fax:732-741-6079
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06680100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7767102Medicaid
G81417Medicare UPIN
NJ02063CKUMedicare ID - Type UnspecifiedMEDICARE ID