MEDICARE: DR. WILLIAM C BOOZAN MD

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	207W00000X	Ophthalmology Physician	163456	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	165878	OTHER	NY	ELDER PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P2349800	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1386741353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM C BOOZAN MD

Provider Business Mailing Address
First Line	:	825 E GATE BLVD
Second Line	:	STE 111
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-2136
Country	:	US
Telephone Number	:	516-804-5200
Fax Number	:	516-240-6540

Provider Business Practice Location Address
First Line	:	1915 NEW HYDE PARK RD
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2028
Country	:	US
Telephone Number	:	516-775-6640
Fax Number	:	516-775-7069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/15/2019

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