Individual
DR. MICHELLE M. BOUYEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1000 SALEM RD, SUITE B, WILLINGBORO, NJ 08046-2852
(877) 476-6642
(914) 819-0061
Mailing address
725 RIVER RD, #299, EDGEWATER, NJ 07020-1171
(877) 476-6642
(914) 819-0061
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA07317700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8739901
—
NJ
01
—
P00953298
RR MCR PTAN
NJ
Enumeration date
11/28/2005
Last updated
01/16/2022
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