NPIMap

Organization Active NPI

Boulevard Multispecialty Medical PC

  • Multi-Specialty Clinic/Center
  • Ozone Park, NY
National Provider Identifier
1730245366
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
24145 Issued in NY
Legal business name
BOULEVARD MULTISPECIALTY MEDICAL PC
Practice address
10149 Woohaven Blvd
Ozone Park, NY 11416
Phone
(718) 641-4900
Fax
(718) 641-4905
NPI assigned
Dec 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Gordon C Davis, DONPI 1124153101
Title
Medical Director
Phone
(718) 641-4900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 24145 NY Primary

Addresses

Primary practice location

10149 Woohaven Blvd
Ozone Park, NY 11416

Mailing address

10149 Woohaven Blvd
Ozone Park, NY 11416
Phone (718) 641-4900

National Provider Directory

National Provider Directory

Locations

9601 Jamaica Ave
Lowr
Woodhaven, NY 11421
Phone (718) 641-4900

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730245366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10149 WOOHAVEN BLVD",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "11416",
            "telephone_number": "718-641-4900",
            "fax_number": "718-641-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10149 WOOHAVEN BLVD",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "11416",
            "telephone_number": "718-641-4900",
            "fax_number": "718-641-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD MULTISPECIALTY MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "718-641-4900",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NY",
            "license": "24145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozone Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.