Khodorkovsky, Boris

Khodorkovsky, Boris is an individual health care provider with primary practice located at 475 Seaview Ave , Staten Island NY 10305-3436. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Khodorkovsky, Boris can be contacted via phone (718) 226-9158.

Contact Information

Primary practice address
475 Seaview Ave Staten Island NY 10305-3436
Phone: (718) 226-9158
Fax: (718) 226-1039
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 231634 New York

Profile Details

NPI number 1558346676
LBN Legal business name Khodorkovsky, Boris
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Dec 9th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558346676 NPPES
New York MEDICAID 02645370

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