MEDICARE: BLVEOCEANS THERAPY SERVICES LLC

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1033042197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLVEOCEANS THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	418 BROADWAY STE N
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:	347-917-6247
Fax Number	:

Provider Business Practice Location Address
First Line	:	3804 BAILEY AVE APT A3
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-2541
Country	:	US
Telephone Number	:	347-917-6247
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JIMMY NIDUAZA
Credential	:	PTA
Telephone Number	:	347-917-6247

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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