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General NPI Number Information
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NPI Number | 1518091214
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Entity Type | Individual
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Provider Name | BORO GAVRIC MD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1901 FIRST AVENUE
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-423-7061
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Fax |
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Provider Business Mailing Address
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Address Line | 373 92ND STREET #A59
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City | BROOKLYN
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State | NY
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Zip | 11209
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Country | US
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Telephone | 718-745-6716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME 89199
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License Number State | FL
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