Provider Demographics
NPI:1386741353
Name:BOOZAN, WILLIAM C (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:BOOZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:825 E GATE BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2136
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:516-240-6540
Practice Address - Street 1:1915 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2028
Practice Address - Country:US
Practice Address - Phone:516-775-6640
Practice Address - Fax:516-775-7069
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY163456207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY165878OtherELDER PLAN
NY01841978Medicaid
NYP2349800OtherOXFORD
NY01841978Medicaid
NY79E552Medicare ID - Type Unspecified