Provider Demographics
NPI:1235437799
Name:BOON, JEFFREY (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BOON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 MARY JEMISON DR
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1285
Mailing Address - Country:US
Mailing Address - Phone:585-243-0098
Mailing Address - Fax:
Practice Address - Street 1:295 MARY JEMISON DR
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1285
Practice Address - Country:US
Practice Address - Phone:585-243-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23014668OtherLICENSE NYS