NPIMap

Organization Active NPI

Northern Boulevard Radiation Oncology LLP

  • Radiation Oncology Physician
  • Flushing, NY
National Provider Identifier
1700884202
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
NORTHERN BOULEVARD RADIATION ONCOLOGY LLP
Practice address
15806 Northern Blvd
Flushing, NY 11358-1641
Phone
(718) 445-3700
NPI assigned
Jul 8, 2005
Last updated
Aug 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Dr. Engracio C Samala, M.D.
Title
Partner
Phone
(718) 445-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

15806 Northern Blvd
Flushing, NY 11358-1641

Mailing address

15806 Northern Blvd
Flushing, NY 11358-1641
Phone (718) 445-3700

Other identifiers 4

IdentifierTypeStateIssuer
0701494OtherNYAETNA U.S. HEALTHCARE
01687214MedicaidNY
135970-A17OtherNYHEALTHFIRST
A1943029OtherNYOXFORD

Other names 1

  • New York Oncology Assoc. LLP Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1700884202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15806 NORTHERN BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113581641",
            "telephone_number": "718-445-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15806 NORTHERN BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113581641",
            "telephone_number": "718-445-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN BOULEVARD RADIATION ONCOLOGY LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "SAMALA",
        "authorized_official_first_name": "ENGRACIO",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "718-445-3700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA U.S. HEALTHCARE",
            "identifier": "0701494",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01687214",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHFIRST",
            "identifier": "135970-A17",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A1943029",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New York Oncology Assoc. LLP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; 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.