Provider Demographics
NPI:1366449795
Name:BOESLER, IZA M (MD)
Entity type:Individual
Prefix:
First Name:IZA
Middle Name:M
Last Name:BOESLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WHITE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1167
Mailing Address - Country:US
Mailing Address - Phone:732-440-8187
Mailing Address - Fax:732-314-7402
Practice Address - Street 1:160 WHITE RD STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1167
Practice Address - Country:US
Practice Address - Phone:732-440-8187
Practice Address - Fax:732-314-7402
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA6861200207RS0012X
NJ25MA06861200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8008809Medicaid
G93781Medicare UPIN
NJ8008809Medicaid