Boris A Konnikow, MD PHD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

204106 Issued in NY

Practice address

11020 71St Rd
Suite 104
Forest Hills, NY 11375-4945

Phone

(718) 263-3355

Fax

(718) 263-3373

NPI assigned

Nov 2, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1973

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

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.

• B Konnikow Physician PC

  • Psychiatry Physician
  • Forest Hills, NY
  • NPI 1083887913
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1841281540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11020 71ST RD",
            "address_2": "SUITE 104",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754914",
            "telephone_number": "917-502-9888",
            "fax_number": "718-263-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11020 71ST RD",
            "address_2": "SUITE 104",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754945",
            "telephone_number": "718-263-3355",
            "fax_number": "718-263-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONNIKOW",
        "first_name": "BORIS",
        "middle_name": "A",
        "credential": "MD PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "204106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02101206",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larisa Leah Kohen, LMSW
• Gary Martin Kolinsky, D.D.S.
• Diana Koltovski, DO
• Avner Kondov, FNP
• Krystian Koniarz
• Kool Smiles Dental PC
• Natalie Koptyev, PHARMD
• Iryna Koriaeva
• Sara M Korman, MA
• Michele Britt Kormendi, MA, CCC-SLP

• Psychiatry Physician in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.