Provider Demographics
NPI:1871571448
Name:FATAKHOV, BORIS N (MD)
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:N
Last Name:FATAKHOV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7111 YELLOWSTONE BLVD
Mailing Address - Street 2:APT 2P
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3541
Mailing Address - Country:US
Mailing Address - Phone:718-575-1547
Mailing Address - Fax:
Practice Address - Street 1:606 WINTHROP ST
Practice Address - Street 2:6 BUILDING
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1709
Practice Address - Country:US
Practice Address - Phone:718-245-2362
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2315672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry