Individual
BORIS ITSKOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2993 OCEAN PKWY, BROOKLYN, NY 11235-8302
(718) 373-0777
(718) 373-8454
Mailing address
2693 ARKANSAS DR, BROOKLYN, NY 11234-6833
(718) 373-0777
(718) 373-8454
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207492
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01799137
—
NY
01
—
2599419
GHI
NY
01
—
BKX072001
AMERICHOICE
NY
01
—
P825169
OXFORD
NY
Enumeration date
05/01/2006
Last updated
02/18/2016
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