Provider Demographics
NPI:1063186617
Name:BOHENSKY, TARA (RN CPHON)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:BOHENSKY
Suffix:
Gender:F
Credentials:RN CPHON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2817
Mailing Address - Country:US
Mailing Address - Phone:917-596-2353
Mailing Address - Fax:
Practice Address - Street 1:3415 BAINBRIDGE AVE # CHAM9
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2403
Practice Address - Country:US
Practice Address - Phone:917-596-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687968163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology