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General NPI Number Information
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NPI Number | 1992975379
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Entity Type | Organization
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Legal Business Name | BOARO CONSULTATIONS NURSE PRACTITIONER IN PSYCHIATRY PC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 3771 NESCONSET HWY SUITE 208B
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1163
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Country | US
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Telephone | 516-721-1976
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Fax | 631-689-2055
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Provider Business Mailing Address
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Address Line | 33 CORNELL AVE
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City | SMITHTOWN
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State | NY
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Zip | 11787-3403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE BOARO
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Credential | FPMHNP-BC
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Telephone | 516-721-1976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F400809
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License Number State | NY
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