Healthcare Provider Details

I. General information

NPI: 1932304235
Provider Name (Legal Business Name): SUBURBAN MEDICAL GROUP, P,A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 SOUTH AVE SUITE 102
FANWOOD NJ
07023-1372
US

IV. Provider business mailing address

282 SOUTH AVE SUITE 102
FANWOOD NJ
07023-1372
US

V. Phone/Fax

Practice location:
  • Phone: 908-889-4600
  • Fax: 908-889-4650
Mailing address:
  • Phone: 908-889-4600
  • Fax: 908-889-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA021365
License Number StateNJ

VIII. Authorized Official

Name: DR. TODD F. BOFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 908-889-4600