Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 240076 | NY |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 240076 | NY |
Y | 2081P2900X | Pain Medicine | 240076 | NY |
NPI | 1700808466 |
---|---|
Provider Name | Boris Abayev |
First Address | Rego Park, NY 11374-3655 |
Second Address | Rego Park, NY 11374-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 25/02/2012 |