Organization
BOULEVARD MEDICAL HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS DIFAZIO (PARTNER)
(718) 325-9532
Entity
Organization
Contact information
Practice address
4238 BRONX BLVD, BRONX, NY 10466-2611
(718) 743-7090
Mailing address
4238 BRONX BLVD, BRONX, NY 10466-2611
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
177458
NY
207R00000X
Internal Medicine Physician
151941
NY
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
130048
NY
207RC0000X
Cardiovascular Disease Physician
106848
NY
207RG0100X
Gastroenterology Physician
105455
NY
207RN0300X
Nephrology Physician
206326
NY
207VG0400X
Gynecology Physician
123469
NY
207W00000X
Ophthalmology Physician
109441
NY
208000000X
Pediatrics Physician
170475
NY
208800000X
Urology Physician
120111
NY
213E00000X
Podiatrist
N003013
NY
Other
Enumeration date
05/12/2006
Last updated
03/16/2020
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