Basic Information
| Provider Information | |||||||||
| NPI: | 1528404753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOULEVARD HOSPITALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 WEST GILBERT STREET | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120051 | ||||||||
| FaxNumber: | 7322120051 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | PASSAIC | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733654300 | ||||||||
| FaxNumber: | 7322120061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2013 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | CALABRO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7322120060 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.