Basic Information
| Provider Information | |||||||||
| NPI: | 1891764718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOUCARD | ||||||||
| FirstName: | HERVE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1374 WHITEHORSE HAMILTON SQUARE RD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086903701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095861319 | ||||||||
| FaxNumber: | 6095861468 | ||||||||
| Practice Location | |||||||||
| Address1: | 1374 WHITEHORSE HAMILTON SQUARE RD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086903701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095861319 | ||||||||
| FaxNumber: | 6095861468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 10/25/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA07717700 | NJ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 103217 | 05 | NJ | MEDICAID | 2622135 | 01 | NJ | UHC | OTHER | 7436839 | 01 | NJ | AETNA PPO | OTHER | P3714409 | 01 | NJ | OXFORD | OTHER | 0104386 | 01 | NJ | GHI | OTHER | 60032894 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 7716069 | 01 | NJ | CIGNA | OTHER | 222233588 | 01 | NJ | HORIZON BC/BS | OTHER | 3K3753 | 01 | NJ | HEALTHNET | OTHER | 01007810900 | 01 | NJ | AMERICHOICE | OTHER | 1216331 | 01 | NJ | AETNA HMO | OTHER |