Healthcare Provider Details

I. General information

NPI: 1346391174
Provider Name (Legal Business Name): BORIS SAGALOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 QUENTIN RD STE 602
BROOKLYN NY
11223-2214
US

IV. Provider business mailing address

700 HICKSVILLE RD
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-4800
  • Fax: 718-375-2519
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA06073600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA06073600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number196707
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number196707
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: