Provider Demographics
NPI:1447417647
Name:BORIS UROLOGY, PA
Entity Type:Organization
Organization Name:BORIS UROLOGY, PA
Other - Org Name:BORIS KLOPUKH, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:VALERIAN
Authorized Official - Last Name:KLOPUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-801-7079
Mailing Address - Street 1:1912 S OCEAN DR
Mailing Address - Street 2:#7C
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5981
Mailing Address - Country:US
Mailing Address - Phone:305-801-7079
Mailing Address - Fax:305-937-7726
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-534-4747
Practice Address - Fax:305-937-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82314208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7894Medicare PIN