Provider Demographics
NPI:1457313512
Name:BOSKIN, MELVIN (DO)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:BOSKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3203
Mailing Address - Country:US
Mailing Address - Phone:631-957-0066
Mailing Address - Fax:631-957-2701
Practice Address - Street 1:900 STRAIGHT PATH
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3203
Practice Address - Country:US
Practice Address - Phone:631-957-0066
Practice Address - Fax:631-957-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00381104Medicaid
NY00381104Medicaid
NYMB01569910Medicare ID - Type Unspecified