Provider Demographics
NPI:1407175565
Name:BOONE, CYNTHIA D
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:BOONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21-20 33RD ROAD
Mailing Address - Street 2:#6A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4225
Mailing Address - Country:US
Mailing Address - Phone:718-391-8419
Mailing Address - Fax:
Practice Address - Street 1:21-20 33RD ROAD
Practice Address - Street 2:#6A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4225
Practice Address - Country:US
Practice Address - Phone:718-391-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006152-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist