Organization
INFECTIOUS DISEASE GROUP OF NORTH JERSEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK BOGHOSSIAN M.D. (PRESIDENT)
(239) 597-0704
Entity
Organization
Contact information
Practice address
631 BROADWAY, BAYONNE, NJ 07002-3846
(239) 597-0704
(239) 597-0704
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8491305
—
NJ
Enumeration date
05/20/2006
Last updated
11/18/2019
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