Organization
BOSTON ROAD MEDICAL PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALERI KAZAKOV MD (OWNER OF THE MEDICAL PRACTICE)
(718) 863-8663
Entity
Organization
Contact information
Practice address
2190 BOSTON RD, SUITE 1N, BRONX, NY 10462-1201
(718) 863-8663
(718) 863-8261
Mailing address
31 AMANDA LN, NEW ROCHELLE, NY 10804-3313
(718) 863-8621
(718) 863-8261
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023196
—
NY
Enumeration date
01/24/2006
Last updated
09/07/2010
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