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Individual

BORIS PRIMAKOV SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
12 KATHLEEN CT, KIAMESHA LAKE, NY 12751-5037
(347) 606-5043
Mailing address
12 KATHLEEN CT, KIAMESHA LAKE, NY 12751-5037
(347) 606-5043

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
489524
NY

Other

Enumeration date
07/17/2014
Last updated
07/17/2014
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