Provider Demographics
NPI:1164240115
Name:BOIARDO, ANTHONY GEORGE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GEORGE
Last Name:BOIARDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JANE ST APT 9G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-0885
Mailing Address - Country:US
Mailing Address - Phone:973-650-3644
Mailing Address - Fax:
Practice Address - Street 1:50 E 98TH ST STE 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6552
Practice Address - Country:US
Practice Address - Phone:973-650-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026755103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)