Healthcare Provider Details

I. General information

NPI: 1851237648
Provider Name (Legal Business Name): JONNY BOIARDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7712 86TH ST
GLENDALE NY
11385-7617
US

IV. Provider business mailing address

7712 86TH ST
GLENDALE NY
11385-7617
US

V. Phone/Fax

Practice location:
  • Phone: 917-691-1623
  • Fax:
Mailing address:
  • Phone: 917-691-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: