Laura Boulos, DO

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

25MB10356200 Issued in NJ

Practice address

69 County Rd 516
Old Bridge, NJ 08857-1416

Phone

(732) 475-2150

Fax

(732) 475-2112

NPI assigned

Dec 19, 2017

Last updated

Aug 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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 Osteopathy

State licenses

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1730695222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 COUNTY RD 516",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088571416",
            "telephone_number": "732-475-2150",
            "fax_number": "732-475-2112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 COUNTY RD 516",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088571416",
            "telephone_number": "732-475-2150",
            "fax_number": "732-475-2112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "LAURA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NJ",
            "license": "25MB10356200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Cardiology Physician in Old Bridge, NJ
• Providers in Old Bridge, NJ by specialty
• Pediatric Cardiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; 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.