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General NPI Number Information
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NPI Number | 1588169437
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Entity Type | Individual
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Provider Name | JOSEPH ELI BOUGANIM MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1924 ROUTE 35 STE 5
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07719-3530
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Country | US
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Telephone | 732-974-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 ROUTE 35 STE 5
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07719-3530
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Country | US
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Telephone | 732-974-8404
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Fax | 732-974-8904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA11385800
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License Number State | NJ
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