Provider Demographics
NPI:1912250572
Name:BOARDMAN, MICHAEL (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BOARDMAN
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 MADISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6323
Mailing Address - Country:US
Mailing Address - Phone:646-291-8391
Mailing Address - Fax:212-980-0073
Practice Address - Street 1:292 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6323
Practice Address - Country:US
Practice Address - Phone:646-291-8391
Practice Address - Fax:212-980-0073
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist