Provider Demographics
NPI:1326018318
Name:ROGER KENNEDY BOYCE MD
Entity Type:Organization
Organization Name:ROGER KENNEDY BOYCE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-826-1177
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142452173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00905404Medicaid
NY00905404Medicaid