Individual provider Active NPI

Boris Lukatskiy, CRNA

  • Certified Registered Nurse Anesthetist
  • Syracuse, NY
National Provider Identifier
1417719840
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN741339 Issued in PA
Practice address
750 E Adams St
Syracuse, NY 13210-1834
Phone
(315) 464-4891
NPI assigned
Jan 30, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 735574 NY
Certified Registered Nurse Anesthetist 367500000X RN741339 PA Primary

Addresses

Primary practice location

750 E Adams St
Syracuse, NY 13210-1834

Mailing address

5784 Widewaters Pkwy
Floor 2
Syracuse, NY 13214-1890
Phone (315) 469-1130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240717004189 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941745624 Reassigns benefits to 1 organization
I20250822002991 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941745624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

500 Universidy Dr
Hershey, PA 17033-2360
Phone (717) 531-8815

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN741339PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physician Group CurrentSince Aug 11, 2025 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Aug 11, 2025 Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
Upstate Medical Anesthesiology Group, Inc. CurrentSince Jul 8, 2024 Accepting new patients

Locations

5784 Widewaters Pkwy
Ste 2
Syracuse, NY 13214
Phone (315) 469-1134

163 Intrepid Ln
#100
Syracuse, NY 13205

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

500 University Dr
#41
Hershey, PA 17033
Phone (717) 531-8202

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

500 University Dr
Hershey, PA 17033
Phone (717) 531-8181

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1417719840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5784 WIDEWATERS PKWY",
            "address_2": "FLOOR 2",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141890",
            "telephone_number": "315-469-1130",
            "fax_number": "315-469-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101834",
            "telephone_number": "315-464-4891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUKATSKIY",
        "first_name": "BORIS",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-30",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "735574",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN741339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.