Provider Demographics
NPI:1992048458
Name:BOFFA, EDWARD JOSEPH JR (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:BOFFA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:JOSEPH
Other - Last Name:BOFFA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5106
Mailing Address - Country:US
Mailing Address - Phone:973-568-2183
Mailing Address - Fax:
Practice Address - Street 1:2 COVENTRY RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5106
Practice Address - Country:US
Practice Address - Phone:973-568-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00396500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor