Provider Demographics
NPI:1316059462
Name:NEMIROVSKY, BORIS (MD)
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:NEMIROVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52036
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-7036
Mailing Address - Country:US
Mailing Address - Phone:215-698-2220
Mailing Address - Fax:215-464-1808
Practice Address - Street 1:9892 BUSTLETON AVE
Practice Address - Street 2:STE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2139
Practice Address - Country:US
Practice Address - Phone:215-698-2220
Practice Address - Fax:215-464-1808
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032418E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
232610603OtherCIGNA
5444501OtherAETNA PPO GROUP PIN
PA0010005980001Medicaid
0100059801OtherAMERICHOICE
098916T50OtherMEDICARE PIN
090307OtherMEDICARE GROUP
98916OtherHIGHMARCK BCBS PIN
P2784771OtherOXFORD HEALTH PLAN
0058439000OtherKHPE KH65 AMERIHEALTH HMO
0876682OtherAETNA HMO GROUP PIN
98916OtherHORIZON
P11221508OtherMULTIPLAN HEALTH EOS
1013277410001OtherDPA GROUP
1702545OtherHIGHMARK BCBS GROUP
249697OtherHEALTHNET
0010005980001OtherDPA
1048941OtherKEYSTONE MERCY
2374620000OtherKHPE KH65 AMERIHEALTH HMO
0058439000OtherKHPE KH65 AMERIHEALTH HMO