Provider Demographics
NPI:1093281735
Name:BORIS BOBYR NP IN ADULT HEALTH PC
Entity Type:Organization
Organization Name:BORIS BOBYR NP IN ADULT HEALTH PC
Other - Org Name:SHORE PARKWAY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBYR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-682-5250
Mailing Address - Street 1:2748 OCEAN AVENUE, 7TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-682-5250
Mailing Address - Fax:208-264-4112
Practice Address - Street 1:2748 OCEAN AVENUE, 7TH FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-682-5250
Practice Address - Fax:208-264-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-20
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty