Provider Demographics
NPI:1790554129
Name:BOISI, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BOISI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 PRESIDENT ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-5040
Mailing Address - Country:US
Mailing Address - Phone:516-509-6294
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1808
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1118
Practice Address - Country:US
Practice Address - Phone:646-837-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program