Provider Demographics
NPI:1982290557
Name:TEMKIN, BORIS
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:TEMKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1707
Mailing Address - Country:US
Mailing Address - Phone:315-687-6467
Mailing Address - Fax:
Practice Address - Street 1:6500 CREEDMOOR RD STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3698
Practice Address - Country:US
Practice Address - Phone:919-825-4000
Practice Address - Fax:919-846-7255
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027709363AM0700X
NC0010-14229363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical