Provider Demographics
NPI:1750164273
Name:MIRKIN, BORIS A
Entity type:Individual
Prefix:MR
First Name:BORIS
Middle Name:A
Last Name:MIRKIN
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 1:1677 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4222
Mailing Address - Country:US
Mailing Address - Phone:191-797-1031
Mailing Address - Fax:
Practice Address - Street 1:1677 E 34TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4222
Practice Address - Country:US
Practice Address - Phone:191-797-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator