1891764718 NPI number — HERVE C BOUCARD M.D.

Table of content: HERVE C BOUCARD M.D. (NPI 1891764718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891764718 NPI number — HERVE C BOUCARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUCARD
Provider First Name:
HERVE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891764718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1374 WHITEHORSE HAMILTON SQUARE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08690-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-586-1319
Provider Business Mailing Address Fax Number:
609-586-1468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1374 WHITEHORSE HAMILTON SQUARE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-586-1319
Provider Business Practice Location Address Fax Number:
609-586-1468
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA07717700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103217 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2622135 . This is a "UHC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7436839 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3714409 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0104386 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60032894 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7716069 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222233588 . This is a "HORIZON BC/BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K3753 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01007810900 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1216331 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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