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Boulevard Multispecialty Medical PC

Clinic/Center, Multi-Specialty in Ozone Park, NY. Organization (NPI-2).

NPI number1730245366
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1730245366
Entity type
Organization (NPI-2)
Legal business name
Boulevard Multispecialty Medical PC
Organization subpart
No
Enumeration date
Dec 28, 2006
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM1300X Clinic/Center, Multi-Specialty24145NYYes

Practice location

10149 Woohaven Blvd
Ozone Park, NY 11416

Phone 718-641-4900 · Fax 718-641-4905

Mailing address

10149 Woohaven Blvd
Ozone Park, NY 11416

Phone 718-641-4900 · Fax 718-641-4905

Authorized official

Gordon C Davis
Medical Director
7186414900

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