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General NPI Number Information
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NPI Number | 1811254980
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Entity Type | Individual
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Provider Name | MICHAEL CONRAD TANDAYAG BOJA D.O
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Gender | Male
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 1150 TEANECK RD SUITE 1
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City | TEANECK
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State | NJ
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Zip | 07666-4825
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Country | US
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Telephone | 201-833-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 42 ESTE PL
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-4121
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | FB5499719
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License Number State | NJ
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