Organization
BOULEVARD MULTISPECIALTY MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON C DAVIS DO (MEDICAL DIRECTOR)
(718) 641-4900
Entity
Organization
Contact information
Practice address
10149 WOOHAVEN BLVD, OZONE PARK, NY 11416
(718) 641-4900
(718) 641-4905
Mailing address
10149 WOOHAVEN BLVD, OZONE PARK, NY 11416
(718) 641-4900
(718) 641-4905
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
24145
NY
Other
Enumeration date
12/28/2006
Last updated
08/22/2020
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