| Boston Road Medical Practice Pc | |
|
2190 Boston Rd Suite 1n Bronx NY 10462-1201 | |
| (718) 863-8663 | |
| (718) 863-8261 |
| Full Name | Boston Road Medical Practice Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2190 Boston Rd, Bronx, New York |
| Authorized Official Name and Position | Valeri Kazakov (OWNER OF THE MEDICAL PRACTICE) |
| Authorized Official Contact | 7188638663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boston Road Medical Practice Pc 31 Amanda Ln New Rochelle NY 10804-3313 Ph: (718) 863-8621 | Boston Road Medical Practice Pc 2190 Boston Rd Suite 1n Bronx NY 10462-1201 Ph: (718) 863-8663 |
| NPI Number | 1306816285 |
|---|---|
| Provider Enumeration Date | 01/24/2006 |
| Last Update Date | 09/07/2010 |
| Medicare PECOS PAC ID | 5799675963 |
|---|---|
| Medicare Enrollment ID | O20040319000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306816285 | NPI | - | NPPES |
| 023196 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Valeri I Kazakov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487633772 PECOS PAC ID: 4789575879 Enrollment ID: I20040413001673 |
| Provider Name | Daniel S Gurell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336164029 PECOS PAC ID: 7719975572 Enrollment ID: I20040503000455 |
| Provider Name | Mladen Solar |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1780677823 PECOS PAC ID: 9537234265 Enrollment ID: I20080814000759 |
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