Provider Demographics
NPI:1124279732
Name:WILLIAM K. BOSS JR MD PA
Entity type:Organization
Organization Name:WILLIAM K. BOSS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-488-1035
Mailing Address - Street 1:385 PROSPECT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2570
Mailing Address - Country:US
Mailing Address - Phone:201-488-1035
Mailing Address - Fax:201-488-2264
Practice Address - Street 1:385 PROSPECT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2570
Practice Address - Country:US
Practice Address - Phone:201-488-1035
Practice Address - Fax:201-488-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03381000173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty