Richard Dickran Bossbaly, CHIROPRACTOR

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00131900 Issued in NJ

Practice address

6419 Bergenline Ave
West New York, NJ 07093-1607

Phone

(201) 854-3440

Fax

(201) 854-0101

NPI assigned

Oct 13, 2006

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338336000000",
    "number": "1740370733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6419 BERGENLINE AVE",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070931607",
            "telephone_number": "201-854-3440",
            "fax_number": "201-854-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6419 BERGENLINE AVE",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070931607",
            "telephone_number": "201-854-3440",
            "fax_number": "201-854-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSSBALY",
        "first_name": "RICHARD",
        "middle_name": "DICKRAN",
        "name_prefix": "Dr.",
        "credential": "CHIROPRACTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00131900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "226297469",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARERAILROAD",
            "identifier": "441350261",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168530901",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIREBCBS",
            "identifier": "X56741",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in West New York, NJ
• Providers in West New York, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; 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.