Provider Demographics
NPI:1376275784
Name:SIMANOVSKIY, BORIS
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:SIMANOVSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WINNERS CIR APT 3A
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5229
Mailing Address - Country:US
Mailing Address - Phone:667-206-0259
Mailing Address - Fax:
Practice Address - Street 1:6 WINNERS CIR APT 3A
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5229
Practice Address - Country:US
Practice Address - Phone:667-206-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR5195253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care