Provider Demographics
NPI:1104024108
Name:BOYM, STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BOYM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:VYACHESLAV
Other - Middle Name:
Other - Last Name:BOYM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:388 ALTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2302
Mailing Address - Country:US
Mailing Address - Phone:718-753-6250
Mailing Address - Fax:
Practice Address - Street 1:1601 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4430
Practice Address - Country:US
Practice Address - Phone:718-714-0700
Practice Address - Fax:718-934-3330
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009308111N00000X, 111NI0013X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX009308OtherLICENSE
NYU76201Medicare UPIN
NYX009308OtherLICENSE