Individual
BORIS MIROCHNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
48 BLUEBERRY LANE, STATEN ISLAND, NY 10312
(718) 967-1585
(718) 967-1585
Mailing address
48 BLUEBERRY LANE, STATEN ISLAND, NY 10312
(718) 967-1585
(718) 967-1585
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
R065562
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02335308
—
NY
Enumeration date
10/25/2006
Last updated
12/27/2007
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