Healthcare Provider Details

I. General information

NPI: 1750164273
Provider Name (Legal Business Name): MR. BORIS A. MIRKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 SWEET MAPLE LN
BOCA RATON FL
33433-1938
US

IV. Provider business mailing address

6526 SWEET MAPLE LN
BOCA RATON FL
33433-1938
US

V. Phone/Fax

Practice location:
  • Phone: 917-971-9319
  • Fax:
Mailing address:
  • Phone: 917-971-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: