Provider Demographics
NPI:1992975379
Name:BOARO CONSULTATIONS NURSE PRACTITIONER IN PSYCHIATRY PC
Entity type:Organization
Organization Name:BOARO CONSULTATIONS NURSE PRACTITIONER IN PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOARO
Authorized Official - Suffix:
Authorized Official - Credentials:FPMHNP-BC
Authorized Official - Phone:516-721-1976
Mailing Address - Street 1:33 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3771 NESCONSET HWY
Practice Address - Street 2:SUITE 208B
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1163
Practice Address - Country:US
Practice Address - Phone:516-721-1976
Practice Address - Fax:631-689-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400809363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty