Provider Demographics
NPI:1487768461
Name:BOUHLEV, OGNIAN (MD)
Entity type:Individual
Prefix:
First Name:OGNIAN
Middle Name:
Last Name:BOUHLEV
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:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-0270
Mailing Address - Country:US
Mailing Address - Phone:631-264-2035
Mailing Address - Fax:631-264-1418
Practice Address - Street 1:60 GUION PLACE
Practice Address - Street 2:SOUND SHORE MEDICAL CENTER
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10802
Practice Address - Country:US
Practice Address - Phone:914-637-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218304207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02096582Medicaid
H20576Medicare UPIN
NY02096582Medicaid