Provider Demographics
NPI:1922081264
Name:KOSHARSKYY, BOLESLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:BOLESLAV
Middle Name:
Last Name:KOSHARSKYY
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 1:3400 BAINBRIDGE AVE SUITE LL400
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2404
Mailing Address - Country:US
Mailing Address - Phone:718-920-7246
Mailing Address - Fax:718-652-4018
Practice Address - Street 1:3400 BAINBRIDGE AVENUE SUITE LL400
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-7246
Practice Address - Fax:718-652-4018
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234893207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02660364Medicaid
NYI30231Medicare UPIN
NY02660364Medicaid