MEDICARE: DR. ALEXANDER BORUKHOV D.M.D.

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	122300000X	Dentist	048512	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	:	1457429474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER BORUKHOV D.M.D.

Provider Business Mailing Address
First Line	:	10857 64TH AVE
Second Line	:	SUITE 1
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1442
Country	:	US
Telephone Number	:	718-830-6263
Fax Number	:	718-830-6263

Provider Business Practice Location Address
First Line	:	10857 64TH AVE
Second Line	:	SUITE 1
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1442
Country	:	US
Telephone Number	:	718-830-6263
Fax Number	:	718-830-6263

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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