| Infectious Disease Group Of North Jersey | |
|
631 Broadway Bayonne NJ 07002-3846 | |
| (239) 597-0704 | |
| (239) 597-0704 |
| Full Name | Infectious Disease Group Of North Jersey |
|---|---|
| Speciality | Internal Medicine |
| Location | 631 Broadway, Bayonne, New Jersey |
| Authorized Official Name and Position | Jack Boghossian (PRESIDENT) |
| Authorized Official Contact | 2395970704 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Disease Group Of North Jersey Po Box 93 Bayonne NJ 07002-0093 Ph: (239) 597-0704 | Infectious Disease Group Of North Jersey 631 Broadway Bayonne NJ 07002-3846 Ph: (239) 597-0704 |
| NPI Number | 1083668479 |
|---|---|
| Provider Enumeration Date | 05/20/2006 |
| Last Update Date | 11/18/2019 |
| Medicare PECOS PAC ID | 6406842640 |
|---|---|
| Medicare Enrollment ID | O20040422000916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083668479 | NPI | - | NPPES |
| 8491305 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Jack Boghossian |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1083666010 PECOS PAC ID: 7012903255 Enrollment ID: I20050110000423 |
| Provider Name | Raymund Vincent Sebastian Sison |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1598023152 PECOS PAC ID: 9335467752 Enrollment ID: I20150415001954 |
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