Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | 305277 | NY |
N | 2086S0127X | Trauma Surgeon | 305277-01 | NY |
NPI | 1336555721 |
---|---|
Provider Name | Boris Dimitrov Hristov |
First Address | Brooklyn, NY 11212-3139 |
Second Address | Brooklyn, NY 11212-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 25/11/2020 |