MEDICARE: LYUBOMYR Y BORYSLAVSKYY DDS

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	054508	NY

General Provider Information

NPI Number	:	1457684052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYUBOMYR Y BORYSLAVSKYY DDS

Provider Business Mailing Address
First Line	:	2333 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4045
Country	:	US
Telephone Number	:	847-452-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4045
Country	:	US
Telephone Number	:	847-452-4138
Fax Number	:

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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