Provider Demographics
NPI:1154037257
Name:BOIMA, DONGONYARO DORYEN
Entity type:Individual
Prefix:
First Name:DONGONYARO
Middle Name:DORYEN
Last Name:BOIMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LASALLE CT
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1012
Mailing Address - Country:US
Mailing Address - Phone:989-916-8851
Mailing Address - Fax:
Practice Address - Street 1:55 SAWKA CIR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1816
Practice Address - Country:US
Practice Address - Phone:860-683-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider