Provider Demographics
NPI:1013963057
Name:KAPELNIK, BORIS MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:MICHAEL
Last Name:KAPELNIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6373 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1607
Mailing Address - Country:US
Mailing Address - Phone:718-896-2020
Mailing Address - Fax:
Practice Address - Street 1:6373 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1607
Practice Address - Country:US
Practice Address - Phone:718-896-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02879716Medicaid
NY08104Medicare PIN