Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 258389 | NY |
NPI | 1346450897 |
---|---|
Provider Name | Dr. Boris Byalik |
First Address | Brooklyn, NY 11235 |
Second Address | Far Rockaway, NY 11691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 24/09/2010 |