Healthcare Provider Details

I. General information

NPI: 1104979376
Provider Name (Legal Business Name): CONRADO BOJA, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 TEANECK RD
TEANECK NJ
07666-4824
US

IV. Provider business mailing address

1182 TEANECK RD
TEANECK NJ
07666-4824
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-9000
  • Fax:
Mailing address:
  • Phone: 201-833-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROEY HINE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 973-751-7515