Provider Demographics
NPI:1336266337
Name:BOLAND, WILLIAM M (CES, NPRT, CPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:BOLAND
Suffix:
Gender:M
Credentials:CES, NPRT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 3RD AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7457
Mailing Address - Country:US
Mailing Address - Phone:917-609-9476
Mailing Address - Fax:212-208-2686
Practice Address - Street 1:247 3RD AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7457
Practice Address - Country:US
Practice Address - Phone:917-609-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS000000225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1180319OtherAETNA HEALTH MANAGEMENT
NJ2946934OtherOHIO CASUALTY GROUP INSUR
CTP3609467OtherOXFORD HEALTH PLANS