| B Konnikow Physician Pc | |
|
11020 71st Rd #104 Forest Hills NY 11375-4945 | |
| (718) 263-3355 | |
| (718) 263-3373 |
| Full Name | B Konnikow Physician Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11020 71st Rd, Forest Hills, New York |
| Authorized Official Name and Position | Boris A Konnikow (PRESIDENT) |
| Authorized Official Contact | 7182633355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| B Konnikow Physician Pc 7636 113th St 5b Forest Hills NY 11375-6513 Ph: (718) 263-3355 | B Konnikow Physician Pc 11020 71st Rd #104 Forest Hills NY 11375-4945 Ph: (718) 263-3355 |
| NPI Number | 1083887913 |
|---|---|
| Provider Enumeration Date | 04/11/2008 |
| Last Update Date | 04/14/2008 |
| Medicare PECOS PAC ID | 9436055951 |
|---|---|
| Medicare Enrollment ID | O20031208000364 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083887913 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 204106 (New York) | Primary |
| Provider Name | Boris A Konnikow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841281540 PECOS PAC ID: 1658277181 Enrollment ID: I20031210000193 |
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