Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X009308 | NY |
N | 111NI0013X | Independent Medical Examiner | X009308 | NY |
N | 111NR0400X | Rehabilitation Chiropractor | X009308 | NY |
NPI | 1104024108 |
---|---|
Provider Name | Steven Boym |
First Address | Staten Island, NY 10305-2302 |
Second Address | Brooklyn, NY 11229-4430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U76201 | (02) | NY |
X009308 | LICENSE (01) | NY |