Provider Demographics
NPI:1881734473
Name:BOHACH, CHRISTINE COLOSON (MSSPED)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:COLOSON
Last Name:BOHACH
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7480 N BAYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-4006
Mailing Address - Country:US
Mailing Address - Phone:631-765-8326
Mailing Address - Fax:631-765-5036
Practice Address - Street 1:7480 N BAYVIEW RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4006
Practice Address - Country:US
Practice Address - Phone:631-765-8326
Practice Address - Fax:631-765-8326
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08038349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist