Provider Demographics
NPI:1174547426
Name:BOYAJIAN, ROBERT WAYNE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAYNE
Last Name:BOYAJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 STATE RT 3
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3857
Mailing Address - Country:US
Mailing Address - Phone:201-865-3100
Mailing Address - Fax:201-865-8311
Practice Address - Street 1:255 STATE RT 3
Practice Address - Street 2:SUITE 203
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3857
Practice Address - Country:US
Practice Address - Phone:201-865-3100
Practice Address - Fax:201-865-8311
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA049024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5093902Medicaid
001962Medicare ID - Type Unspecified
NJ5093902Medicaid