Provider Demographics
NPI:1518139898
Name:BORIS SAGALOVICH, MD PC
Entity type:Organization
Organization Name:BORIS SAGALOVICH, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-471-0002
Mailing Address - Street 1:2408 OCEAN AVE
Mailing Address - Street 2:MO UNIT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3565
Mailing Address - Country:US
Mailing Address - Phone:801-471-0002
Mailing Address - Fax:718-621-1884
Practice Address - Street 1:2408 OCEAN AVE
Practice Address - Street 2:MO UNIT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3565
Practice Address - Country:US
Practice Address - Phone:801-471-0002
Practice Address - Fax:718-621-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01673692Medicaid
NY01673692Medicaid