Rafael Boruchov, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

50056907 Issued in NY

Practice address

11620 Queens Blvd
Forest Hills, NY 11375-7055

Phone

(718) 507-7781

Fax

(347) 652-1760

NPI assigned

Aug 24, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• 99 Nassau Ave Dental PLLC

  dba Dental Made Easy

  • Dental Clinic/Center
  • Brooklyn, NY
  • NPI 1922509348
  NPD Authorized official

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

{
    "created_epoch": "1377302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1295169472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11620 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757055",
            "telephone_number": "718-507-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11620 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757055",
            "telephone_number": "718-507-7781",
            "fax_number": "347-652-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORUCHOV",
        "first_name": "RAFAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-24",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "50056907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arsalan Boodhun
• Boon Speech Therapy PC
• Howard Scott Boriskin, MD
• Mangesh Rajan Borkar
• Elcy Borrero Tovar
• Alexander Borukhov, D.M.D.
• Shamuel Borukhov, PHARMD
• Mazoltuv Borukhova, MD
• Natella Borukhova, PHARM.D
• Oksana Borukhova

• Dentist in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.