=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205089935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA ROSE BOEMIO MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2008
-----------------------------------------------------
Last Update Date | 10/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 OLD HOOK RD
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07675-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-666-8787
-----------------------------------------------------
Fax | 201-358-6686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 W 57TH ST SUITE 104
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-3159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-666-8787
-----------------------------------------------------
Fax | 201-358-6686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 001120-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------