Organization · NPI-2

Boulevard Medical Healthcare

Chiropractor, Orthopedic · Bronx, NY

NPI number1891746368
StatusActive
Last updated in NPPESMar 16, 2020

Details

NPI
1891746368
Entity type
Organization (NPI-2)
Legal business name
Boulevard Medical Healthcare
Organization subpart
No
Enumeration date
May 12, 2006
Certification date
Mar 16, 2020
Last updated
Mar 16, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111NX0800X Chiropractor, Orthopedic177458NYYes
207R00000X Internal Medicine151941NY
207RA0201X Internal Medicine, Allergy & Immunology130048NY
207RC0000X Internal Medicine, Cardiovascular Disease106848NY
207RG0100X Internal Medicine, Gastroenterology105455NY
207RN0300X Internal Medicine, Nephrology206326NY
207VG0400X Obstetrics & Gynecology, Gynecology123469NY
207W00000X Ophthalmology109441NY
208000000X Pediatrics170475NY
208800000X Urology120111NY
213E00000X PodiatristN003013NY

Practice location

4238 Bronx Blvd
Bronx, NY 10466-2611

Phone 718-743-7090

Mailing address

4238 Bronx Blvd
Bronx, NY 10466-2611

Authorized official

Louis Difazio
Partner
7183259532

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