Individual
DWIGHT BOSTIC JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
86 S HARRISON ST STE A, EAST ORANGE, NJ 07018-1748
(973) 324-7879
Mailing address
110 HALCYON PL, ROSELLE, NJ 07203-1512
(908) 875-7860
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NJ
Other
Enumeration date
11/28/2017
Last updated
11/28/2017
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