Organization
BORIS ITSKOVICH, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BORIS ITSKOVICH M.D. (PRESIDENT)
(718) 373-0777
Entity
Organization
Contact information
Practice address
3009 OCEAN PKWY, BROOKLYN, NY 11235-8302
(718) 373-0777
(718) 373-8454
Mailing address
3009 OCEAN PKWY, BROOKLYN, NY 11235-8302
(718) 373-0777
(718) 373-8454
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
207492
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01799137
—
NY
Enumeration date
07/29/2013
Last updated
07/29/2013
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