Individual provider Active NPI

Boris Nektalov, DC

  • Chiropractor
  • Flushing, NY
National Provider Identifier
1285950568
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X011815 Issued in NY
Practice address
15330 77TH Rd
Flushing, NY 11367-3425
Phone
(718) 275-9000
NPI assigned
Apr 12, 2010
Last updated
Dec 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X011815 NY Primary

Addresses

Primary practice location

15330 77TH Rd
Flushing, NY 11367-3425

Mailing address

10850 71St Ave Ste Lower
Forest Hills, NY 11375-4564
Phone (718) 275-9000

Other names 1

  • Dr. Bukhor Niktalov Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100812000890 NY Practitioner - Chiropractic 4880728807 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X011815NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Nektalov Family Chiropractic & PT PLLC Chiropractor CurrentSince Mar 14, 2011 Accepting new patients
Nektalov Family Chiropractic PLLC Chiropractor Past Accepting new patients
Alexander Khavash DC PC Chiropractor Past Accepting new patients

Locations

15031 Union Tpke
Kew Gardens Hills, NY 11367
Phone (347) 454-2050

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1285950568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10850 71ST AVE STE LOWER",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754564",
            "telephone_number": "718-275-9000",
            "fax_number": "516-784-4678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15330 77TH RD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113673425",
            "telephone_number": "718-275-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEKTALOV",
        "first_name": "BORIS",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-12",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X011815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BUKHOR",
            "last_name": "NIKTALOV",
            "prefix": "DR.",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.