MEDICARE: DR. BOLESLAV KOSHARSKYY 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	234893	NY
2	207L00000X	Anesthesiology Physician	25MA08645800	NJ

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	:	1922081264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOLESLAV KOSHARSKYY M.D.

Provider Business Mailing Address
First Line	:	90 MATAWAN RD STE 302
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-2653
Country	:	US
Telephone Number	:	732-441-7177
Fax Number	:	732-441-7165

Provider Business Practice Location Address
First Line	:	3400 BAINBRIDGE AVENUE SUITE LL400
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2404
Country	:	US
Telephone Number	:	718-920-7246
Fax Number	:	718-652-4018

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	01/20/2026

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