Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 036177 | NY |
NPI | 1104936806 |
---|---|
Provider Name | Dr. Barry K Borger |
First Address | North Bellmore, NY 11710 |
Second Address | North Bellmore, NY 11710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |