Healthcare Provider Details

I. General information

NPI: 1326018318
Provider Name (Legal Business Name): ROGER KENNEDY BOYCE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 BEDFORD AVE
BROOKLYN NY
11225-3903
US

IV. Provider business mailing address

1821 BEDFORD AVE
BROOKLYN NY
11225-3903
US

V. Phone/Fax

Practice location:
  • Phone: 718-826-1177
  • Fax:
Mailing address:
  • Phone: 718-826-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number142452
License Number StateNY

VIII. Authorized Official

Name: ROGER KENNEDY BOYCE
Title or Position: SOLE PROPRIETER
Credential:
Phone: 718-826-1177