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General NPI Number Information
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NPI Number | 1043847833
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Entity Type | Individual
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Provider Name | SAMUEL JOHN BOSCO DO
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 32 STRAWBERRY HILL CT STE 4
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City | STAMFORD
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State | CT
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Zip | 06902-2594
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Country | US
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Telephone | 203-353-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 32 STRAWBERRY HILL CT STE 4
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City | STAMFORD
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State | CT
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Zip | 06902-2594
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Country | US
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Telephone | 203-353-0000
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Fax | 203-357-8109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 080698-DO
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License Number State | CT
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