Healthcare Provider Details

I. General information

NPI: 1033042197
Provider Name (Legal Business Name): BLVEOCEANS THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 BAILEY AVE APT A3
BRONX NY
10463-2541
US

IV. Provider business mailing address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 347-917-6247
  • Fax:
Mailing address:
  • Phone: 347-917-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JIMMY NIDUAZA
Title or Position: OWNER
Credential: PTA
Phone: 347-917-6247