Provider Demographics
NPI:1578545364
Name:BUKHAROVICH, YAROSLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:YAROSLAV
Middle Name:
Last Name:BUKHAROVICH
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 1:8420 85TH AVE
Mailing Address - Street 2:#2
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1217
Mailing Address - Country:US
Mailing Address - Phone:718-805-6767
Mailing Address - Fax:
Practice Address - Street 1:1200 GRAVESEND NECK RD
Practice Address - Street 2:#1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4256
Practice Address - Country:US
Practice Address - Phone:718-332-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02194865Medicaid
NY36S411Medicare ID - Type Unspecified
NY02194865Medicaid