Marvin Tillman Boyd, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

25MA03839300 Issued in NJ

Practice address

350 Boulvard the Boyd Renal Clinic
St. Mary's Hospital Ambulatory Services,
Passaic, NJ 07055

Phone

(973) 594-7800

Fax

(973) 594-7801

NPI assigned

Feb 2, 2007

Last updated

Oct 2, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1417095126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2306",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075092306",
            "telephone_number": "973-742-3300",
            "fax_number": "973-582-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 BOULVARD THE BOYD RENAL CLINIC",
            "address_2": "ST. MARY'S HOSPITAL AMBULATORY SERVICES,",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "07055",
            "telephone_number": "973-594-7800",
            "fax_number": "973-594-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYD",
        "first_name": "MARVIN",
        "middle_name": "TILLMAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA03839300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0371106",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward W. Boehm Jr., DMD
• Hayde Maricruz Bolanos, APN
• Nirali P Borad, OTRL
• Yosef C Borenstein, DPT
• Boulevard Hospitalists LLC
• Armando Medina Braganza, MD
• Kunal Brahmbhatt, M.D.
• Holanda P Bravo, M.D.
• Alan Brewster, D.C.
• Deborah Brickman, MS, RD, CDN, CDCES

• Nephrology Physician in Passaic, NJ
• Providers in Passaic, NJ by specialty
• Nephrology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.