Provider Demographics
NPI:1376826859
Name:VISTMAN, BOZHENA (EDM)
Entity Type:Individual
Prefix:
First Name:BOZHENA
Middle Name:
Last Name:VISTMAN
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 83RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5229
Mailing Address - Country:US
Mailing Address - Phone:718-639-0700
Mailing Address - Fax:718-639-7684
Practice Address - Street 1:3524 83RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5229
Practice Address - Country:US
Practice Address - Phone:718-639-0700
Practice Address - Fax:718-639-7684
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health