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NPI Code Detail

MEDICARE: DR. JOHN A. BOSTROM M.D.

MEDICARE: DR. JOHN A. BOSTROM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician25MA02455300NJ

General Provider Information

NPI Number : 1497708242
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN A. BOSTROM M.D.
Provider Business Mailing Address
First Line : 846 BERKLEY ST
Second Line : APT. C
City : NEW MILFORD
State : NJ
Zip : 07646-5405
Country : US
Telephone Number : 201-576-0999
Fax Number :
Provider Business Practice Location Address
First Line : 610 VALLEY HEALTH PLZ
Second Line :
City : PARAMUS
State : NJ
Zip : 07652-3607
Country : US
Telephone Number : 201-265-8200
Fax Number : 201-265-0366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 02/02/2012

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