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General NPI Number Information
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NPI Number | 1801511779
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Entity Type | Organization
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Legal Business Name | BORIS YAGUDA MEDICAL PC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 06/23/2024
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Provider Practice Location Address
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Address Line | 1664 E 14TH ST STE 3B
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City | BROOKLYN
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State | NY
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Zip | 11229-1155
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Country | US
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Telephone | 347-763-9793
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Fax |
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Provider Business Mailing Address
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Address Line | 1664 E 14TH ST STE 3B
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City | BROOKLYN
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State | NY
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Zip | 11229-1155
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Country | US
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Telephone | 732-740-4257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BORIS YAGUDA
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Credential | MD
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Telephone | 732-740-4257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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