Provider Demographics
NPI:1396826863
Name:BOODIN, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BOODIN
Suffix:
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 1:338 N MOUNTAIN AVE
Mailing Address - Street 2:PO BOX 43665
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1020
Mailing Address - Country:US
Mailing Address - Phone:973-746-4641
Mailing Address - Fax:973-746-2443
Practice Address - Street 1:338 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1020
Practice Address - Country:US
Practice Address - Phone:973-746-4641
Practice Address - Fax:973-746-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01674600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist