1992975379 NPI number — BOARO CONSULTATIONS NURSE PRACTITIONER IN PSYCHIATRY PC

Table of content: (NPI 1992975379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992975379 NPI number — BOARO CONSULTATIONS NURSE PRACTITIONER IN PSYCHIATRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARO CONSULTATIONS NURSE PRACTITIONER IN PSYCHIATRY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1992975379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 CORNELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11787-3403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3771 NESCONSET HWY
Provider Second Line Business Practice Location Address:
SUITE 208B
Provider Business Practice Location Address City Name:
SOUTH SETAUKET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11720-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-721-1976
Provider Business Practice Location Address Fax Number:
631-689-2055
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BOARO
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-721-1976

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  F400809 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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