Organization
CONCILIUM MEDICAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YAROSLAV BUKHAROVICH (PRESIDENT)
(718) 938-3564
Entity
Organization
Contact information
Practice address
1200 GRAVESEND NECK RD, BROOKLYN, NY 11229-4256
(718) 332-3555
Mailing address
8420 85TH AVE, WOODHAVEN, NY 11421-1217
(718) 805-6767
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
221545
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02194865
—
NY
Enumeration date
05/12/2006
Last updated
04/09/2008
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