Provider Demographics
NPI:1215028956
Name:PEYSIN, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:PEYSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 BAY PKWY
Mailing Address - Street 2:SUITE 1M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2548
Mailing Address - Country:US
Mailing Address - Phone:718-234-5100
Mailing Address - Fax:718-234-5200
Practice Address - Street 1:8100 BAY PKWY
Practice Address - Street 2:SUITE 1M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2548
Practice Address - Country:US
Practice Address - Phone:718-234-5100
Practice Address - Fax:718-234-5200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02085296Medicaid
NYH16575Medicare UPIN
NY02085296Medicaid