Healthcare Provider Details

I. General information

NPI: 1528435963
Provider Name (Legal Business Name): FARYN BOMSER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 GRAND AVE
BALDWIN NY
11510-3148
US

IV. Provider business mailing address

1760 166TH ST
WHITESTONE NY
11357-3315
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095880
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: