Provider Demographics
NPI:1346081197
Name:BOOZER, ANDRE STANLEY
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:STANLEY
Last Name:BOOZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-8808
Mailing Address - Country:US
Mailing Address - Phone:267-768-9154
Mailing Address - Fax:
Practice Address - Street 1:3310 ROUTE 47
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-8808
Practice Address - Country:US
Practice Address - Phone:267-768-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator