Provider Demographics
NPI:1669452207
Name:DARAKCHIEV, BORIMIR J (MD)
Entity Type:Individual
Prefix:
First Name:BORIMIR
Middle Name:J
Last Name:DARAKCHIEV
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 1:380 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4403
Mailing Address - Country:US
Mailing Address - Phone:631-422-5371
Mailing Address - Fax:631-893-8012
Practice Address - Street 1:380 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4403
Practice Address - Country:US
Practice Address - Phone:631-422-5371
Practice Address - Fax:631-893-8012
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2366731207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02699636Medicaid
NYP00422646OtherMEDICARE RR
NYI36462Medicare UPIN
NY02699636Medicaid