Healthcare Provider Details

I. General information

NPI: 1366449795
Provider Name (Legal Business Name): IZA M BOESLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WHITE RD STE 201
LITTLE SILVER NJ
07739-1167
US

IV. Provider business mailing address

160 WHITE RD STE 201
LITTLE SILVER NJ
07739-1167
US

V. Phone/Fax

Practice location:
  • Phone: 732-440-8187
  • Fax: 732-314-7402
Mailing address:
  • Phone: 732-440-8187
  • Fax: 732-314-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06861200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA6861200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: