Provider Demographics
NPI:1104979376
Name:CONRADO BOJA, M.D. LLC
Entity type:Organization
Organization Name:CONRADO BOJA, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-751-7515
Mailing Address - Street 1:1182 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4824
Mailing Address - Country:US
Mailing Address - Phone:201-833-9000
Mailing Address - Fax:
Practice Address - Street 1:1182 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4824
Practice Address - Country:US
Practice Address - Phone:201-833-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082106Medicare ID - Type Unspecified