MEDICARE: DR. BORIS SAGALOVICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	25MA06073600	NJ
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	25MA06073600	NJ
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	196707	NY
4	207RP1001X	Pulmonary Disease Physician	196707	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346391174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BORIS SAGALOVICH MD

Provider Business Mailing Address
First Line	:	2408 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3565
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2408 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3565
Country	:	US
Telephone Number	:	718-339-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	03/31/2021

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