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NPI Code Detail

MEDICARE: ARTHUR BOOMGARD

MEDICARE: ARTHUR BOOMGARD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner358503NY

General Provider Information

NPI Number : 1255287579
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARTHUR BOOMGARD
Provider Business Mailing Address
First Line : 85 W BURNSIDE AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-4015
Country : US
Telephone Number : 718-716-4400
Fax Number :
Provider Business Practice Location Address
First Line : 85 W BURNSIDE AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-4015
Country : US
Telephone Number : 718-716-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ ARTHUR BOOMGARD ” Practice Location

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