Provider Demographics
NPI:1295340313
Name:YUNATANOV, BORIS D
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:D
Last Name:YUNATANOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 SAUNDERS ST APT D5
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3204
Mailing Address - Country:US
Mailing Address - Phone:718-687-9043
Mailing Address - Fax:
Practice Address - Street 1:711 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5428
Practice Address - Country:US
Practice Address - Phone:718-855-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist