Provider Demographics
NPI:1710487285
Name:SOUTHERN BOULEVARD MEDICAL CARE PC
Entity Type:Organization
Organization Name:SOUTHERN BOULEVARD MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZUHEIR
Authorized Official - Middle Name:JAMIL
Authorized Official - Last Name:SAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-613-4966
Mailing Address - Street 1:45 LUDLOW ST FL 5
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1947
Mailing Address - Country:US
Mailing Address - Phone:914-613-4966
Mailing Address - Fax:914-613-4967
Practice Address - Street 1:45 LUDLOW ST FL 5
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-613-4966
Practice Address - Fax:914-613-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248691208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100039OtherMEDICARE
NY03230233Medicaid