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General NPI Number Information
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NPI Number | 1346707593
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Entity Type | Individual
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Provider Name | CRISOR A. J. BOYARD CRNA, ACNP
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Gender | Male
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 355 BARD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-1664
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Country | US
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Telephone | 718-818-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 575 LEXINGTON, NY,
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 718-216-0405
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 682890
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 431661
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 682890
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License Number State | NY
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