Provider Demographics
NPI:1265972665
Name:VANDENBOSCH, JUSTIN ELIOT (NP)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ELIOT
Last Name:VANDENBOSCH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505455
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-5455
Mailing Address - Country:US
Mailing Address - Phone:720-244-8528
Mailing Address - Fax:
Practice Address - Street 1:529 MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-1122
Practice Address - Country:US
Practice Address - Phone:617-600-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily