Provider Demographics
NPI:1578814133
Name:BOULOS, GIACINTA (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:GIACINTA
Middle Name:
Last Name:BOULOS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:GIACINTA
Other - Middle Name:
Other - Last Name:LOBELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3940
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4326
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant