MEDICARE: DR. BOBACK M BEROOKHIM 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	208800000X	Urology Physician	253004	NY

General Provider Information

NPI Number	:	1639330160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBACK M BEROOKHIM M.D.

Provider Business Mailing Address
First Line	:	186 E 76TH ST FL 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2822
Country	:	US
Telephone Number	:	212-434-4650
Fax Number	:	212-434-3250

Provider Business Practice Location Address
First Line	:	186 E 76TH ST FL 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2822
Country	:	US
Telephone Number	:	212-434-4650
Fax Number	:	212-434-3250

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	07/07/2014

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