Provider Demographics
NPI:1457458176
Name:RIPA, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:RIPA
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 1:230 174TH ST APT 2014
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5769
Mailing Address - Country:US
Mailing Address - Phone:305-424-0903
Mailing Address - Fax:718-891-1101
Practice Address - Street 1:1250 E HALLANDALE BLVD
Practice Address - Street 2:500
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6305
Practice Address - Country:US
Practice Address - Phone:305-424-0903
Practice Address - Fax:718-891-1101
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207307208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8459209Medicaid
NY01755811Medicaid
NJ8459209Medicaid
NY01755811Medicaid