Individual
MR. BRIAN W. BOOCKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
414 TATUM ST, WOODBURY, NJ 08096-3499
(856) 848-3880
(856) 848-4895
Mailing address
500 GROVE ST, SUITE 100, HADDON HEIGHTS, NJ 08035-1761
(856) 796-9200
(856) 796-9397
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
25MP00280500
NJ
363AS0400X
Surgical Physician Assistant
Primary
25MP00280500
NJ
Other
Enumeration date
03/07/2012
Last updated
04/03/2014
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