Provider Demographics
NPI:1588478630
Name:BOONTON MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:BOONTON MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-800-8748
Mailing Address - Street 1:223 W MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1165
Mailing Address - Country:US
Mailing Address - Phone:973-335-8656
Mailing Address - Fax:973-335-8986
Practice Address - Street 1:223 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1165
Practice Address - Country:US
Practice Address - Phone:973-335-8656
Practice Address - Fax:973-335-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty