Provider Demographics
NPI:1619416294
Name:BOLESLAV KOSHARSKYY, MEDICAL PRACTICE, P.C.
Entity Type:Organization
Organization Name:BOLESLAV KOSHARSKYY, MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BOLESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHARSKYY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-402-2606
Mailing Address - Street 1:44 W 127TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3888
Mailing Address - Country:US
Mailing Address - Phone:917-402-2606
Mailing Address - Fax:
Practice Address - Street 1:44 W 127TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3888
Practice Address - Country:US
Practice Address - Phone:917-402-2606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234893207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI30231Medicare UPIN