Healthcare Provider Details

I. General information

NPI: 1376524785
Provider Name (Legal Business Name): BORIS SACHAKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 BAY PKWY
BROOKLYN NY
11214-3359
US

IV. Provider business mailing address

6610 YELLOWSTONE BLVD APT 4D
FOREST HILLS NY
11375-2042
US

V. Phone/Fax

Practice location:
  • Phone: 718-621-1800
  • Fax: 718-621-1365
Mailing address:
  • Phone: 719-896-5662
  • Fax: 718-621-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number228151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: