Healthcare Provider Details

I. General information

NPI: 1750351797
Provider Name (Legal Business Name): MARK E BOSELEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/18/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE PLAINS RD STE 201
TARRYTOWN NY
10591-5838
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 400
TARRYTOWN NY
10591-5107
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-3053
  • Fax: 914-631-2807
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMD00047231
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number331028
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number331028
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: