Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 403684 | NY |
NPI | 1003405713 |
---|---|
Provider Name | Gregory Paul Bovenzi |
First Address | New York, NY 10029-6504 |
Second Address | New York, NY 10029-6504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2021 |
Last Update Date | 01/11/2021 |