Provider Demographics
NPI:1528159951
Name:BOZAN, MICHAEL J (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BOZAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073
Mailing Address - Country:US
Mailing Address - Phone:201-438-7474
Mailing Address - Fax:201-438-8255
Practice Address - Street 1:237 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073
Practice Address - Country:US
Practice Address - Phone:201-438-7474
Practice Address - Fax:201-438-8255
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00462300111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ610919Medicare ID - Type Unspecified