Healthcare Provider Details

I. General information

NPI: 1205089935
Provider Name (Legal Business Name): TERESA ROSE BOEMIO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2008
Last Update Date: 10/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 OLD HOOK RD
WESTWOOD NJ
07675-3131
US

IV. Provider business mailing address

333 W 57TH ST SUITE 104
NEW YORK NY
10019-3159
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-8787
  • Fax: 201-358-6686
Mailing address:
  • Phone: 201-666-8787
  • Fax: 201-358-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001120-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: