Provider Demographics
NPI:1588651079
Name:BOSTON CHILDRENS HEALTH PHYSICIANS LLP
Entity type:Organization
Organization Name:BOSTON CHILDRENS HEALTH PHYSICIANS LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-594-4280
Mailing Address - Street 1:40 SUNSHINE COTTAGE RD # 1N-C08
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1524
Mailing Address - Country:US
Mailing Address - Phone:914-593-1659
Mailing Address - Fax:914-593-1790
Practice Address - Street 1:755 N BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-366-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D0681397OtherCLIA
NY02729519Medicaid