Provider Demographics
NPI:1851732895
Name:BOIVIN, GENEVIEVE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:
Last Name:BOIVIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W 37TH ST APT 9F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-2117
Mailing Address - Country:US
Mailing Address - Phone:347-476-7036
Mailing Address - Fax:
Practice Address - Street 1:23 BOND ST STE 8
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2025
Practice Address - Country:US
Practice Address - Phone:516-482-0329
Practice Address - Fax:516-482-0401
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059087-1204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery