Provider Demographics
NPI:1861401978
Name:BOENIG, REGINALD (DO)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:
Last Name:BOENIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7592 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1458
Mailing Address - Country:US
Mailing Address - Phone:845-342-0746
Mailing Address - Fax:845-342-2739
Practice Address - Street 1:7592 N BROADWAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1458
Practice Address - Country:US
Practice Address - Phone:845-342-0746
Practice Address - Fax:845-342-2739
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX06421Medicare ID - Type UnspecifiedMEDICARE ID NUMBER