Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 045002-1 | NY |
Y | 213EG0000X | General Practice | 045002-1 | NY |
NPI | 1003932583 |
---|---|
Provider Name | Blanca L Borboa |
First Address | Queens Village, NY 11429-1206 |
Second Address | Queens Village, NY 11429-1206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01531502 | (05) | NY |