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General NPI Number Information
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NPI Number | 1164240115
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Entity Type | Individual
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Provider Name | ANTHONY GEORGE BOIARDO PHD
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Gender | Male
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 50 E 98TH ST STE 1B
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City | NEW YORK
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State | NY
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Zip | 10029-6552
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Country | US
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Telephone | 973-650-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 100 JANE ST APT 9G
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City | NEW YORK
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State | NY
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Zip | 10014-0885
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Country | US
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Telephone | 973-650-3644
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Fax |
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 026755
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 026755
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License Number State | NY
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