GARY J BOUCHARD, PA-C, Medical GREENLAWN, NY

Contact Information

GARY J BOUCHARD, PA-C

190 BROADWAY
GREENLAWN, NY 11740-2120

Phone: 732-668-4192
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Medical	363AM0700X	97	Physician Assistant
Physician Assistant	363A00000X	97	Physician Assistant

Indicates primary specialty

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NPI Profile & details for GARY J BOUCHARD · (Male)

NPI #	`1457505083`
Status	Active
Credentials	PA-C (Physician Assistant-Certified)
Entity	Individual
Enumeration date	11/10/2008
Last updated	06/12/2019 - About 7 years ago
Sole proprietor ¹	No
Identifiers	NJ License # MP 00002600 NY License # 003223
Hospital affiliation(s)	ST CHARLES HOSPITAL - (Acute Care) 200 BELLE TERRE ROAD PORT JEFFERSON, NY 11777

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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GARY J BOUCHARD, PA-C – NPI #1457505083Medical

Contact Information

Specialty

Medical

Physician Assistant

NPI Profile & details for GARY J BOUCHARD · (Male)

Reviews for GARY J BOUCHARD

GARY J BOUCHARD, PA-C – NPI #1457505083
Medical