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BORIS ITSKOVICH, MD
NPI 1164864369
Clinic/Center - Primary Care in Brooklyn, NY

Active since July 29, 2013CLIA 33D0940978 · Waiver
3009 OCEAN PKWY, BROOKLYN, NY 11235(718) 373-0777(718) 373-8454 Get Directions Write a Review

NPPES record last updated: July 29, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Boris Itskovich, Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BORIS ITSKOVICH, MD (NPI 1164864369) is a healthcare organization registered as a primary care in Brooklyn, New York and active in the NPI registry since July 2013. The organization holds a CLIA Waiver certificate valid through December 9, 2026 and lists Boris Itskovich, President, as its authorized official.

NPPES Registry Identity

NPI1164864369
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameBORIS ITSKOVICH, MD
Location Address3009 OCEAN PKWYBrooklyn, NY 11235-8302
Mailing Address3009 Ocean PkwyBrooklyn, NY 11235-8302 · (718) 373-0777 · Fax (718) 373-8454
Phone(718) 373-0777
Fax(718) 373-8454
Organization SubpartNo
Authorized OfficialBoris ItskovichPresident · (718) 373-0777
Enumeration DateJuly 29, 2013
✔ NPI 1164864369 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in NY · 207492
3009 OCEAN PKWY, Brooklyn, NY 11235
Open in Google Maps ↗

Other Identifiers 2

Medicaid01799137NY
Medicare UPING60164NY

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D0940978

Boris Itskovich MD PC · Brooklyn, NY
Active · expires Dec 9, 2026
CLIA Number33D0940978
Laboratory TypePhysician Office
Certificate Effective DateDecember 10, 2024
Certificate Expiration DateDecember 9, 2026
Laboratory DirectorDr. Boris Itskovich
Laboratory Phone(718) 373-0777
Laboratory LocationBoris Itskovich MD PC2993 Ocean Parkway, Brooklyn, NY 11235
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Boris Itskovich, MD's NPI number?

The NPI number for Boris Itskovich, MD is 1164864369. It was assigned to this organization in the NPPES registry on July 29, 2013.

Where is Boris Itskovich, MD located?

Boris Itskovich, MD is located at 3009 Ocean Pkwy, Brooklyn, NY 11235. The listed phone number is (718) 373-0777.

What is Boris Itskovich, MD's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Boris Itskovich, MD hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D0940978) is associated with this NPI, valid through December 9, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Boris Itskovich, MD was last updated on July 29, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.