Provider Demographics
NPI:1134110547
Name:BOYCE, ROGER K (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:K
Last Name:BOYCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3903
Mailing Address - Country:US
Mailing Address - Phone:718-826-1177
Mailing Address - Fax:
Practice Address - Street 1:1821 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3903
Practice Address - Country:US
Practice Address - Phone:718-826-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00905494Medicaid
NY00905494Medicaid
NY4807100Medicare ID - Type Unspecified