MEDICARE: MR. STUART JEFF BOKSER MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00162200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44SC00162200	OTHER	NJ	LIC CLINICAL SOCIAL WORKE

General Provider Information

NPI Number	:	1508856766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STUART JEFF BOKSER MSW

Provider Business Mailing Address
First Line	:	22 GEORGIAN BAY DR
Second Line	:
City	:	MORGANVILLE
State	:	NJ
Zip	:	07751-1322
Country	:	US
Telephone Number	:	732-532-3703
Fax Number	:	732-536-1715

Provider Business Practice Location Address
First Line	:	BLDING 1075 STEPHENSON AVE
Second Line	:	PATTERSON ARMY HEALTH CLINIC
City	:	FT. MONMOUTH
State	:	NJ
Zip	:	07703
Country	:	US
Telephone Number	:	732-532-3703
Fax Number	:	732-532-6429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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