Provider Demographics
NPI:1730183088
Name:BOORADY, JOSEPH THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:BOORADY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1627
Mailing Address - Country:US
Mailing Address - Phone:973-543-7203
Mailing Address - Fax:212-780-4997
Practice Address - Street 1:1240 SUSSEX TPKE
Practice Address - Street 2:STE 4
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2944
Practice Address - Country:US
Practice Address - Phone:973-895-9292
Practice Address - Fax:973-895-1991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA005353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU43775Medicare UPIN
NJ047759Medicare ID - Type UnspecifiedNJMEDICARE