Individual provider Active NPI

Vasilis Boutis, M.S. ED

  • Specialist
  • New York, NY
National Provider Identifier
1407101298
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Practice address
236 2ND Ave
New York, NY 10003-2704
Phone
(212) 683-8905
Fax
(212) 683-8906
NPI assigned
Jul 17, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NY Primary

Addresses

Primary practice location

236 2ND Ave
New York, NY 10003-2704

Mailing address

144-91 37TH Ave.
Flushing, NY 11354
Phone (516) 662-4786

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
Master of Science

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407101298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144-91 37TH AVE.",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11354",
            "telephone_number": "516-662-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 2ND AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100032704",
            "telephone_number": "212-683-8905",
            "fax_number": "212-683-8906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTIS",
        "first_name": "VASILIS",
        "credential": "M.S. ED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.