Provider Demographics
NPI:1912178583
Name:DR CHARLES BOXMAN
Entity Type:Organization
Organization Name:DR CHARLES BOXMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-645-0101
Mailing Address - Street 1:2404 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6637
Mailing Address - Country:US
Mailing Address - Phone:609-645-0101
Mailing Address - Fax:609-345-7410
Practice Address - Street 1:2404 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6637
Practice Address - Country:US
Practice Address - Phone:609-645-0101
Practice Address - Fax:609-345-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4172620001Medicare NSC