Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MC03260 | NJ |
NPI | 1104260165 |
---|---|
Provider Name | Dr. Gary Stepan Bozian |
First Address | Newark, NJ 07102-2923 |
Second Address | Newark, NJ 07102-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 22/04/2013 |