DR. JOHANE GILDADE BOURSIQUOT M.D.
NPI 1275801219
General Practice in Bronx, NY

Q: What is Johane Boursiquot's NPI number?

The NPI number for Johane Boursiquot is 1275801219. It was assigned to this individual provider in the NPPES registry on December 6, 2011.

Q: What is Johane Boursiquot's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Johane Boursiquot was last updated on March 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 06, 2011PECOS Enrolled

2015 GRAND CONCOURSE, BRONX, NY 10453(718) 299-7295(718) 299-6797 Get Directions Write a Review

NPPES record last updated: March 19, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 19, 2021, Feb 6, 2020, Aug 13, 2019 and 2 more (5 updates tracked since 2017).

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About Dr. Johane Gildade Boursiquot M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JOHANE GILDADE BOURSIQUOT M.D. (NPI 1275801219) is an individual general practice provider in Bronx, New York, licensed in New York (277201) and active in the NPI registry since December 2011. She is enrolled in Medicare PECOS and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1275801219

Entity TypeIndividualFemale

Primary Taxonomy208D00000X

Provider Legal NameDR. JOHANE GILDADE BOURSIQUOTCredential: M.D.

Location Address2015 GRAND CONCOURSEBronx, NY 10453-4303

Mailing Address1436 Williamsbridge RdBronx, NY 10461-2507 · (718) 618-0401 · Fax (347) 479-1303

Phone(718) 299-7295

Fax(718) 299-6797

Sole ProprietorNo

Enumeration DateDecember 6, 2011

Last NPPES UpdateMarch 19, 20215 updates tracked since enumeration

NPPES CertifiedJanuary 1, 2021

✔ NPI 1275801219 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in NY · 277201

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedFamily MedicineTaxonomy 207Q00000X · License MT205076 (PA)

2015 GRAND CONCOURSE, Bronx, NY 10453

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Secondary Practice Locations 4

Location 12015 Grand ConcourseBronx, NY 10453-4303 · Phone (718) 299-7295 · Fax (718) 299-6797

Location 27924 Jamaica AveWoodhaven, NY 11421-1801 · Phone (718) 805-0037 · Fax (347) 960-9468

Location 3150 Riverside DrNew York, NY 10024-2298 · Phone (646) 505-3500

Location 4515 Madison Ave Ste 9083New York, NY 10022-5403 · Phone (718) 954-7338 · Fax (877) 319-1942

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Johane Gildade Boursiquot M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MANA RAO M.D.

Internal Medicine (Infectious Disease)