Basic Information
| Provider Information | |||||||||
| NPI: | 1346707593 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYARD | ||||||||
| FirstName: | CRISOR | ||||||||
| MiddleName: | A. J. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA, ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1808 25TH RD # 2 | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111023428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182160405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100191147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125234000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2019 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 363LA2100X | 431661 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 367500000X | 128211 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163WC0200X | 682890 | NY | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.