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BOSTON ROAD MEDICAL PRACTICE PC NPI 1306816285


NPI Information

NPI: 1306816285
Provider Name: BOSTON ROAD MEDICAL PRACTICE PC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 33D1008791

Address:
2190 BOSTON RD
SUITE 1N
BRONX, NY
ZIP 10462
Phone: (718) 863-8663
Get Directions

BOSTON ROAD MEDICAL PRACTICE PC is an internal medicine in Bronx, NY. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. BOSTON ROAD MEDICAL PRACTICE PC NPI is 1306816285. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2190 BOSTON RD
SUITE 1N
BRONX, NY
ZIP 10462-201
Phone: (718) 863-8663
Fax: (718) 863-8261

The provider's authorized official is Valeri Kazakov .
The authorized official title is Owner Of The Medical Practice and has the following contact phone number (718) 863-8663.

The CLIA number assigned to this NPI record is 33D1008791 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/24/2006 and was last updated on 9/7/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1023196MEDICAIDNEW YORK
2W39261MEDICARE ID-TYPE UNSPECIFIEDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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