Provider Demographics
NPI:1619926821
Name:TRIF, BORIS
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:TRIF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E 8TH ST
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2754
Mailing Address - Country:US
Mailing Address - Phone:718-336-4499
Mailing Address - Fax:718-336-2013
Practice Address - Street 1:280 QUENTIN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1628
Practice Address - Country:US
Practice Address - Phone:718-336-4499
Practice Address - Fax:718-336-2013
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV07124Medicare UPIN
NYX02V41Medicare ID - Type Unspecified