Healthcare Provider Details

I. General information

NPI: 1871888222
Provider Name (Legal Business Name): MR. BORIS YABLONOVSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HARVARD AVE
ALLSTON MA
02134-2702
US

IV. Provider business mailing address

121 HARVARD AVE
ALLSTON MA
02134-2702
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-2210
  • Fax: 617-787-1688
Mailing address:
  • Phone: 617-254-2210
  • Fax: 617-787-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: