Provider Demographics
NPI:1932842846
Name:BOLD & BOSS INC.
Entity Type:Organization
Organization Name:BOLD & BOSS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RALLIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-742-6811
Mailing Address - Street 1:51 FALLON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3605
Mailing Address - Country:US
Mailing Address - Phone:347-742-6811
Mailing Address - Fax:
Practice Address - Street 1:51 FALLON AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3605
Practice Address - Country:US
Practice Address - Phone:347-742-6811
Practice Address - Fax:347-521-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier