Boulevard Medical Healthcare

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

177458 Issued in NY

Legal business name

BOULEVARD MEDICAL HEALTHCARE

Practice address

4238 Bronx Blvd
Bronx, NY 10466-2611

Phone

(718) 743-7090

NPI assigned

May 12, 2006

Organization subpart

No

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

Authorized official

Name

Louis Difazio

Title

Partner

Phone

(718) 325-9532

Specialties & licenses 11

Addresses

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1891746368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4238 BRONX BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104662611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4238 BRONX BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104662611",
            "telephone_number": "718-743-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD MEDICAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "DIFAZIO",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "718-325-9532"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "NY",
            "license": "177458",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "151941",
            "primary": false
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "NY",
            "license": "130048",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "106848",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "105455",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "206326",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "123469",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "109441",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "170475",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "NY",
            "license": "120111",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N003013",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucas Richard Bottcher, DC
• Laura Boucai, M.D.
• Daniel Ismail Boudani, MD
• Myriam Bougatef, MD
• Yasmine Bouguetaib
• Marina Boulos
• Toufic Boulos, D.M.D
• Jason Peter Boulware, D.O.
• Mako Boundjou
• Victoria Bourdeau

• Orthopedic Chiropractor in Bronx, NY
• Providers in Bronx, NY by specialty
• Orthopedic Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.