Healthcare Provider Details

I. General information

NPI: 1346502952
Provider Name (Legal Business Name): BARBARA EILEEN BOSS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 JERSEY AVE
GREENWOOD LAKE NY
10925-4024
US

IV. Provider business mailing address

69 JERSEY AVE
GREENWOOD LAKE NY
10925-4024
US

V. Phone/Fax

Practice location:
  • Phone: 845-742-3695
  • Fax:
Mailing address:
  • Phone: 845-742-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: