Active NPI
Bruce S Boltuch, PHD
- Psychologist
- Old Tappan, NJ
National Provider Identifier
1174672166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1274
- Practice address
- 88 Willow Drive
Old Tappan, NJ 07675-6831 - Phone
- (201) 666-7717
- Fax
- (201) 666-7717
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1274 | NJ | Primary |
Addresses
Primary practice location
88 Willow Drive
Old Tappan, NJ 07675-6831
Mailing address
88 Willow Drive
Old Tappan, NJ 07675-6831
Phone (201) 666-7717
Other names 1
- Dr. Bruce Boltuch
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1274 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174672166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "88 WILLOW DRIVE",
"city": "OLD TAPPAN",
"state": "NJ",
"postal_code": "076756831",
"telephone_number": "201-666-7717",
"fax_number": "201-666-7717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "88 WILLOW DRIVE",
"city": "OLD TAPPAN",
"state": "NJ",
"postal_code": "076756831",
"telephone_number": "201-666-7717",
"fax_number": "201-666-7717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTUCH",
"first_name": "BRUCE",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "1274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRUCE",
"last_name": "BOLTUCH",
"prefix": "DR.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Old Tappan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.