=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407901309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONE HEALTH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 ROSA RD SUITE 380
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12308-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-386-3686
-----------------------------------------------------
Fax | 518-386-3612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 ROSA RD SUITE 380
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12308-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-386-3686
-----------------------------------------------------
Fax | 518-386-3612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF, FINANCIAL OFFICER
-----------------------------------------------------
Name | JOHN FRANCIS ASSINI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 518-386-3686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 122341
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------