MEDICARE: DR. IRVIN D BOUGH JR. M.D.

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	207Y00000X	Otolaryngology Physician	201905-1	NY
2	207Y00000X	Otolaryngology Physician	25MA06358300	NJ

General Provider Information

NPI Number	:	1598710899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRVIN D BOUGH JR. M.D.

Provider Business Mailing Address
First Line	:	660 WHITE PLAINS RD FL 4
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5139
Country	:	US
Telephone Number	:	914-984-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 FROM RD STE 170
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3517
Country	:	US
Telephone Number	:	201-722-9850
Fax Number	:	201-722-9850

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/25/2022

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Directions to “ DR. IRVIN D BOUGH JR. M.D.” Practice Location

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