Individual
DR. JACK BOGHOSSIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
631 BROADWAY, BAYONNE, NJ 07002-3846
(973) 364-2682
(973) 364-1430
Mailing address
PO BOX 93, BAYONNE, NJ 07002-0093
(239) 597-0704
(239) 597-0709
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MA81581
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4555104
—
NJ
Enumeration date
05/17/2006
Last updated
03/26/2015
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