Provider Demographics
NPI:1407832306
Name:BOSTOCK, DEBORAH JEAN (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:BOSTOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:HERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:852 ROUTE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2343
Practice Address - Country:US
Practice Address - Phone:973-450-1991
Practice Address - Fax:973-528-8009
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286649207Q00000X
VA0101241804207QG0300X
TNMD19935207Q00000X
NJ25MA11294900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine