1518139898 NPI number — BORIS SAGALOVICH, MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518139898 NPI number — BORIS SAGALOVICH, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BORIS SAGALOVICH, MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518139898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 OCEAN AVE
Provider Second Line Business Mailing Address:
MO UNIT
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11229-3565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-471-0002
Provider Business Mailing Address Fax Number:
718-621-1884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2408 OCEAN AVE
Provider Second Line Business Practice Location Address:
MO UNIT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-3565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-471-0002
Provider Business Practice Location Address Fax Number:
718-621-1884
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SAGALOVICH
Authorized Official First Name:
BORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-471-0002

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  196707 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01673692 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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