Provider Demographics
NPI:1609821297
Name:CHERNOBILSKY, BORIS (MD)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:CHERNOBILSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 SUMMERFIELD ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3567
Mailing Address - Country:US
Mailing Address - Phone:917-846-4617
Mailing Address - Fax:
Practice Address - Street 1:923 5TH AVE APT NEW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2649
Practice Address - Country:US
Practice Address - Phone:212-444-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238669207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03233401Medicaid
NY03233401Medicaid