Individual
BORIS BAKANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
440 W 114TH ST FL 6, NEW YORK, NY 10025-1796
(212) 523-8570
Mailing address
1660 E 66TH ST, BROOKLYN, NY 11234
(718) 404-8156
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F311621
NY
Other
Enumeration date
12/04/2023
Last updated
01/23/2025
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