Provider Demographics
NPI:1376524785
Name:SACHAKOV, BORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:SACHAKOV
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 1:6610 YELLOWSTONE BLVD
Mailing Address - Street 2:APT 4D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2042
Mailing Address - Country:US
Mailing Address - Phone:719-896-5662
Mailing Address - Fax:718-621-1365
Practice Address - Street 1:8405 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3359
Practice Address - Country:US
Practice Address - Phone:718-621-1800
Practice Address - Fax:718-621-1365
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228151208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02685349Medicaid
NY7004F1Medicare ID - Type Unspecified
NY02685349Medicaid