Healthcare Provider Details

I. General information

NPI: 1649349465
Provider Name (Legal Business Name): ANDREW H BOYARSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST CLINICAL ACADEMIC BUILDING - SUITE 4100
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

66 W GILBERT ST 2ND FLOOR
TINTON FALLS NJ
07701-4947
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7920
  • Fax: 732-235-7079
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25MA03942200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: