Provider Demographics
NPI:1669535571
Name:DALIT, BOAZ (PSYD)
Entity type:Individual
Prefix:MR
First Name:BOAZ
Middle Name:
Last Name:DALIT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 AVENUE OF THE AMERICAS STE 602
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8409
Mailing Address - Country:US
Mailing Address - Phone:212-366-0760
Mailing Address - Fax:212-614-0225
Practice Address - Street 1:412 AVENUE OF THE AMERICAS STE 602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8409
Practice Address - Country:US
Practice Address - Phone:212-366-0760
Practice Address - Fax:212-614-0225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV2J191Medicare ID - Type UnspecifiedPSYCHOLOGIST