Individual
MR. BOAZ ITSHAKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSOM
Contact information
Practice address
286 BEACON RD, BETHANY, CT 06524
(203) 393-2773
Mailing address
286 BEACON RD, BETHANY, CT 06524-3080
(203) 393-2773
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
000258
CT
171100000X
Acupuncturist
002459-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1244899
TAX ID
—
Enumeration date
03/03/2007
Last updated
08/11/2018
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