Individual
GARY J BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
190 BROADWAY, GREENLAWN, NY 11740-2120
(732) 668-4192
Mailing address
190 BROADWAY, GREENLAWN, NY 11740-2120
(732) 668-4192
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MP 00002600
NJ
363AM0700X
Medical Physician Assistant
Primary
003223
NY
Other
Enumeration date
11/10/2008
Last updated
06/12/2019
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