Boris L Prakhina, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA068923 Issued in NJ

Practice address

33-00 Broadway
Suite # 209
Fair Lawn, NJ 07410-4617

Phone

(201) 796-7666

Fax

(201) 796-5570

NPI assigned

May 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Institute for Diagnosis & Treatment of Pain

  • Specialist
  • Fair Lawn, NJ
  • NPI 1033227004
  NPD (past)
• Professional Anesthesiology Services, PA

  • Pain Medicine (Anesthesiology) Physician
  • Passaic, NJ
  • NPI 1801832282
  NPD (past)
• Professional Pain Management Services PA

  • Interventional Pain Medicine Physician
  • Clifton, NJ
  • NPI 1194036111
  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344556800000",
    "number": "1609087659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33-00 BROADWAY",
            "address_2": "SUITE # 209",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074104617",
            "telephone_number": "201-796-7666",
            "fax_number": "201-796-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33-00 BROADWAY",
            "address_2": "SUITE # 209",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074104617",
            "telephone_number": "201-796-7666",
            "fax_number": "201-796-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRAKHINA",
        "first_name": "BORIS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2012-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "MA068923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7979100",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Plaza Health Center, LLC
• Plaza Wellness & Health Center LLC
• Plymouth Park Pharmacy Inc
• Point to Point Transportation, LLC
• Marina Polyak
• Precision Physical Therapy, Inc
• Preferred Life Medical Services
• Premier Medical Equipment, LLC
• Emily Prendergast, MS, RD
• Joshua M Prensky, DDS

• Specialist in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2012; 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.