Individual
JASON PETER BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2353 HUGHES AVE, APT 1A, BRONX, NY 10458-8267
(646) 737-4364
Mailing address
515 VALLEY ST STE 203, MAPLEWOOD, NJ 07040-4300
(908) 663-2929
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
24237
CA
207P00000X
Emergency Medicine Physician
Primary
259532-1
NY
207P00000X
Emergency Medicine Physician
25MB09297500
NJ
207P00000X
Emergency Medicine Physician
286222
MA
207P00000X
Emergency Medicine Physician
DO00706
RI
Other
Enumeration date
01/04/2011
Last updated
05/05/2026
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