Basic Information
| Provider Information | |||||||||
| NPI: | 1588651079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON CHILDRENS HEALTH PHYSICIANS LLP | ||||||||
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| OtherOrganizationName: | BOSTON CHILDRENS HEALTH PHYSICIANS PEDIATRIC ENDOCRINOLOGY DIVISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 SUNSHINE COTTAGE RD # 1N-C08 | ||||||||
| Address2: | |||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105951524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145931659 | ||||||||
| FaxNumber: | 9145931790 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 N BROADWAY STE 400 | ||||||||
| Address2: | |||||||||
| City: | SLEEPY HOLLOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143663400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | NEWMAN | ||||||||
| AuthorizedOfficialFirstName: | LEONARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9145944280 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | NY | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 33D0681397 | 01 | NY | CLIA | OTHER | 02729519 | 05 | NY | MEDICAID |