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General NPI Number Information
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NPI Number | 1003389347
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Entity Type | Organization
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Legal Business Name | BORUKHOV RADIOLOGY PLLC
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 13821 QUEENS BLVD
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City | BRIARWOOD
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State | NY
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Zip | 11435-2641
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Country | US
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Telephone | 718-480-1250
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Fax | 718-480-6720
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Provider Business Mailing Address
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Address Line | 13821 QUEENS BLVD
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City | BRIARWOOD
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State | NY
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Zip | 11435-2641
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Country | US
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Telephone | 718-480-1250
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Fax | 718-480-6720
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Authorized Official
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Title or Position | MD
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Name | DAVID BORUKHOV
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Credential |
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Telephone | 718-480-1250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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