Provider Demographics
NPI:1659758621
Name:NP ADULT HEALTH & GERONTOLOGY PC
Entity Type:Organization
Organization Name:NP ADULT HEALTH & GERONTOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSHAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-729-5904
Mailing Address - Street 1:126 CORBIN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4811
Mailing Address - Country:US
Mailing Address - Phone:347-729-5904
Mailing Address - Fax:
Practice Address - Street 1:126 CORBIN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4811
Practice Address - Country:US
Practice Address - Phone:347-729-5904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY569215-1163W00000X
NYF306361-1363LA2200X
NYF340890-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100123835Medicare PIN