Individual
BORIS A KONNIKOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
11020 71ST RD, SUITE 104, FOREST HILLS, NY 11375-4945
(718) 263-3355
(718) 263-3373
Mailing address
11020 71ST RD, SUITE 104, FOREST HILLS, NY 11375-4914
(917) 502-9888
(718) 263-3373
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
204106
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02101206
—
NY
Enumeration date
11/02/2005
Last updated
08/14/2013
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