Provider Demographics
NPI:1639330160
Name:BEROOKHIM, BOBACK M (MD)
Entity Type:Individual
Prefix:DR
First Name:BOBACK
Middle Name:M
Last Name:BEROOKHIM
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 1:186 E 76TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2822
Mailing Address - Country:US
Mailing Address - Phone:212-434-4650
Mailing Address - Fax:212-434-3250
Practice Address - Street 1:186 E 76TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2822
Practice Address - Country:US
Practice Address - Phone:212-434-4650
Practice Address - Fax:212-434-3250
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253004208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology