Healthcare Provider Details

I. General information

NPI: 1528091899
Provider Name (Legal Business Name): BORIS ROYAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 SCIENCE PARK DR STE 210
BEACHWOOD OH
44122-7328
US

IV. Provider business mailing address

25700 SCIENCE PARK DR STE 210
BEACHWOOD OH
44122-7328
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax: 216-450-1614
Mailing address:
  • Phone: 216-450-1613
  • Fax: 216-450-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-081164
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.081164
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: