Provider Demographics
NPI:1255399408
Name:BOJA, CONRADO A III (MD)
Entity type:Individual
Prefix:DR
First Name:CONRADO
Middle Name:A
Last Name:BOJA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1182 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4824
Mailing Address - Country:US
Mailing Address - Phone:201-833-9000
Mailing Address - Fax:201-833-9510
Practice Address - Street 1:1182 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4824
Practice Address - Country:US
Practice Address - Phone:201-833-9000
Practice Address - Fax:201-833-9510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA057894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6177301Medicaid
F80498Medicare UPIN
NJ6177301Medicaid