Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 247973 | NY |
Y | 2080P0216X | Pediatric Rheumatologist | 25MA09256300 | NJ |
NPI | 1528232394 |
---|---|
Provider Name | Alexis Boneparth |
First Address | New Brunswick, NJ 08901-1935 |
Second Address | New York, NY 10032-1559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2008 |
Last Update Date | 04/11/2021 |