Provider Demographics
NPI:1265436174
Name:BOOZAN, JOHN MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATTHEW
Last Name:BOOZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:33 OVERLOOK RD
Mailing Address - Street 2:STE 407
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3564
Mailing Address - Country:US
Mailing Address - Phone:908-277-1166
Mailing Address - Fax:908-277-0141
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:STE 407
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3564
Practice Address - Country:US
Practice Address - Phone:908-277-1166
Practice Address - Fax:908-277-0141
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04666900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40941OtherAETNA/US HEALTHCARE
NJUS 287OtherOXFORD
NJ3313808Medicaid
NJ3313808Medicaid
NJUS 287OtherOXFORD