Provider Demographics
NPI:1639251499
Name:BOMS, GLORIA (AUD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:BOMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4311
Mailing Address - Country:US
Mailing Address - Phone:516-466-4299
Mailing Address - Fax:516-466-4298
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4311
Practice Address - Country:US
Practice Address - Phone:516-466-4299
Practice Address - Fax:516-466-4298
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY442231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM70721Medicare ID - Type Unspecified