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General NPI Number Information
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NPI Number | 1518449693
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Entity Type | Individual
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Provider Name | BORIS PORSHNEV DNP CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 2680 E 19TH ST APT 4L
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City | BROOKLYN
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State | NY
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Zip | 11235-3306
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Country | US
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Telephone | 347-693-3995
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Fax |
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Provider Business Mailing Address
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Address Line | 99 BEAUVOIR AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-3533
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Country | US
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Telephone | 347-693-3995
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 635226-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 119484
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License Number State | NJ
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