Healthcare Provider Details

I. General information

NPI: 1356264790
Provider Name (Legal Business Name): BRIAN BOVIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 TILTON RD
NORTHFIELD NJ
08225-1879
US

IV. Provider business mailing address

39 GLASGOW RD
WILLIAMSTOWN NJ
08094-2942
US

V. Phone/Fax

Practice location:
  • Phone: 848-260-2190
  • Fax: 848-260-2190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00208400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: