Provider Demographics
NPI:1801511779
Name:BORIS YAGUDA MEDICAL PC
Entity type:Organization
Organization Name:BORIS YAGUDA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-740-4257
Mailing Address - Street 1:1664 E 14TH ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1155
Mailing Address - Country:US
Mailing Address - Phone:732-740-4257
Mailing Address - Fax:
Practice Address - Street 1:1664 E 14TH ST STE 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1155
Practice Address - Country:US
Practice Address - Phone:347-763-9793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty