Healthcare Provider Details

I. General information

NPI: 1356608905
Provider Name (Legal Business Name): BORIS SHKOLNIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE DEPARTMENT OF INTERNAL MEDICINE
ALBANY NY
12208
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE DEPARTMENT OF INTERNAL MEDICINE
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number280525
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number280525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: