Provider Demographics
NPI:1184998791
Name:BOAMBES, IOANA (LAC)
Entity type:Individual
Prefix:MS
First Name:IOANA
Middle Name:
Last Name:BOAMBES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 ELK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HALCOTT CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12430-1446
Mailing Address - Country:US
Mailing Address - Phone:646-644-7080
Mailing Address - Fax:
Practice Address - Street 1:585 ELK CREEK RD
Practice Address - Street 2:
Practice Address - City:HALCOTT CENTER
Practice Address - State:NY
Practice Address - Zip Code:12430-1446
Practice Address - Country:US
Practice Address - Phone:646-446-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist