MEDICARE: DR. TAYLOR JOAN BOSTONIAN MD

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1821738550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR JOAN BOSTONIAN MD

Provider Business Mailing Address
First Line	:	230 OLD FORGE RD
Second Line	:
City	:	MONROE TOWNSHIP
State	:	NJ
Zip	:	08831-1487
Country	:	US
Telephone Number	:	908-227-7568
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 S ORANGE AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:	973-972-5018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	03/30/2022

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