Basic Information
| Provider Information | |||||||||
| NPI: | 1831235704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSCO | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ROUTE 376 | ||||||||
| Address2: | STE H | ||||||||
| City: | WAPPINGERS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125906496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455924915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 FOSTER RD | ||||||||
| Address2: | |||||||||
| City: | HOPEWELL JUNCTION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125336123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452264590 | ||||||||
| FaxNumber: | 8552002625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 003057 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.