Individual
BORIS KOSTROMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 CLARA MAASS DR, BELLEVILLE, NJ 07109-3550
(973) 450-2000
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5157
(703) 890-2650
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA07495200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9029206
—
NJ
Enumeration date
12/01/2006
Last updated
06/17/2016
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