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General NPI Number Information
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NPI Number | 1457856403
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Entity Type | Organization
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Legal Business Name | BGY PODIATRY PC
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 9810 64TH AVE APT GB
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City | REGO PARK
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State | NY
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Zip | 11374-2501
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Country | US
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Telephone | 718-896-4367
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Fax | 718-606-9521
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Provider Business Mailing Address
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Address Line | 9810 64TH AVE APT GB
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City | REGO PARK
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State | NY
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Zip | 11374-2501
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Country | US
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Telephone | 718-896-4367
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Fax | 718-606-9521
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BORIS G YUABOV
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Credential | DPM
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Telephone | 718-896-4367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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